Winona Choice will not work with Preferred one Federated's provider. I think they see them as a competitor.
Tom O. Severson 265 E. Mark Box 736 Winona, Mn. 55987 507 452 3402 ext 214 Direct 452 4743 Office Switchboard [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Monday, October 27, 2003 9:21 AM To: Online Democracy Subject: FW: [Winona] It's the Insurance Companies Tom & others, Did you know there are networks within networks? The Winona market with Healthpartners is networked to La Crosse and Rochester's Mayo is considered out of the network however if one chooses Lake City Clinic as their primary provider with Healthpartners they are networked with Rochester and services are then in network. Policy holders have the right to change primary providers every thirty day according to their policy. If they don't change primary providers all claims are considered out of network. It just takes a phone call to play the game. Maybe we could market a board game "Not in my Network Monopoly" Don't you just love it! Paul Double Sent: Monday, October 27, 2003 5:57 AM I agree and Winona Choice is the most discriminatory of all. We have Federated insurance, which is able to deal with the Mayo system through Prefered One, and provide us better coverage at a lower cost than if we use Winona providers. Federated and I have repeatedly tried to deal with Winona Choice but cannot get to first base. Tom Severson -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Sunday, October 26, 2003 8:16 PM To: Online Democracy Subject: FW: [Winona] It's the Insurance Companies There is a great article in the Sunday October 26 2003 by Dr. Frank Bures on page 4C. I don't know if he has been in the background enjoying our discussion but the article titled "Medical coverage is really quite arbitrary" is right on target for our discussion. He discusses discounts and the insurance industry. I know earlier I had posted the AMA testimony to Federal Trade Commission which also illustrates the concerns of many providers and more important the danger or increasing power of insurance companies. I would however take issue with one point in the article. The Robinson-Patman Act prohibits "for profit" providers from price discrimination between "Business" competitors. "Third Party Administrators" in Single Payer Systems such as administered (Health Reimbursement Arrangements) HRA's are competitors of the insurance industry and as such must receive similar discounts or the providers will be in trouble with the Justice Department and the FTC not to mention state laws which may be more encompassing. While some providers may attempt to circumvent the law by saying that it applies only to goods not services I would encourage them to go to the FTC site as services are being included. It should also be noted that the FTC is addressing networks in relation to the Sherman Anti-Trust Act and restraint of trade issues between out of network providers and those in network. Some FTC documents indicate that when Non-Profit Providers collaborate with For-Profit Providers the non-profits may be at risk on loosing their non-profit exemption from Robinson-Patman. This, in my opinion, would be great for consumers as the special discounts that non-profits receive on prescription drugs would be offered to your local drug stores. I am amazed by the number of consumers (patients) who think they need insurance because they remember the artificial invoice they receive first for services rendered verses the final "real invoice" after all the write offs and discounts are applied. Amazed also at the number of providers who only hurt themselves by their billing/pricing policies but many are waking up that they must speak out, offer cash customers the same prices they offer insurance companies, support Third Party Administrators as Single Payer Systems or they will always be under the thumb of their master "the insurance industry". What is sad and scary is: Insurance controls what employers and employees shall pay Insurance controls what is covered by their plan and where you must go to be served Insurance controls what the provider will receive on the threat that they might build their own clinic The President thinks this industry should be a part of the solution - Hell they are the problem! Paul Double
<<attachment: winmail.dat>>
