Kathy and others
http://www.usatoday.com/money/industries/health/2005-05-05-uninsured-agreement_x.htm
Kathy this is the link. It is my understanding that 16 hospitals
have signed on thus far.
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To help me understand this--are you saying that the agreement is that
uninsured persons will only be billed the "usual and
customary" fee that the
big guys like the "blues" pay in their contracts?
Kathy
Response
It is my understanding and hope that it
mean that all consumers will be given the same price with or without
insurance. So if a hospital agrees to discount a bill for a Blue Cross insured
40 percent then anyone paying cash would receive the 40 % discount. That
does not mean that Minnesota Care or Medicare rates would be used as those are mandated
not negotiated. Only the contracted amounts that the non profit hospitals
have “agreed” to accept or the discount they offered would be
available to all.
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I understand that the reasoning for setting fees the way providers do
is to
make up for the folks who either don't or can't pay. Another
reason is that
if a provider accepts MA or medicare patients, those 3rd parties pay
well
below the "usual and customary".
Kathy
Response
What has been found is that many who do
not purchase insurance can pay the bill if the price is fair and reasonable.
Banks may be willing to spread the cost of a loan over time to easy payment.
Since the price charged to insurance companies is discounted but negotiated
providers are or should be selling those services at a level that they make a
profit or a least break even. It eliminates the need to buy insurance
just to get the discount since the premium is in most cases, and in the long
haul, most always more that the cost of the services provided. That is
why insurance companies have made money. Government discounts or prices are
not negotiated but mandated and that is why they are excluded.
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I think the idea is that the folks who have coverage with a straight
80/20
will pay 20% of the fee that is higher than what the big insurance
companies
say is the "usual and customary".
Kathy
Response
The usual and customary is a can of worms and
you are right that that practice should also be eliminated as an option for the
insurance companies. I believe that is why Blue Cross in now rating the
hospitals and planning to double the co-payments for some hospitals because
they believe the hospitals are overcharging based on comparative data.
What I read is that the insurance companies are informing patients as to who is
charging more or discounting less so that people will know they are paying more
than what others charge for similar services. It may also be a wake up to the
provider to control costs and in particular those costs not related to patient
care so that their prices come down. Advertising!
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You are correct that uninsured people end up having to pay a greater
amount
to the provider than comes out of the pocket of any insured person--at
least
what the insured person pays directly to the provider. If you
allow for the
huge amount in premiums and deductables that the insured person pays,
are
the fees really so unfair to the
uninsured patients? Possibly not.
Kathy
Response
The consumer should have the right to be
able to get fair prices. The market price is the price that is “agreed
to by the providers” when they establish the fees with the insurance
companies. That, in my opinion, should also be the fair price for all and
that is what this agreement provides. No provider has to give anyone
discounts except the “Government” Therefore why should I have to
buy insurance just to get a fair price and that is half the reason to buy
insurance. The only other reason for insurance is to protect your assets
in the event of a catastrophic illness and expense.
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Isn't part of the problem that the third parties who collect all those
huge
premiums and deductables also set the "usual and customary"
fee? MA and
Medicare also set their own payment schedules which are quite low
compared
to even the big blues' usual. To me this is not a "free
market" system
where the market sets the price. It is a system controlled by the
big
insurance companies who are making lots of money for their investors on
our
backs!! (Can you tell I feel strongly about this subject?)
Kathy
Response
The only gun held to the head of the non
profit provider, that I’m aware of is Medicare and that is because the
non profits “must accept”. I do not believe that any provider
is required to accept any other fee from any other party unless “they
have agreed to do so”. That is a free market. If Wal-Mart
tells me I must sell them tarps for $1.00 I have the right to say no and so
does any provider. More and more providers are not accepting insurance,
the major exception is the non profit hospitals. Also some large “for
profit” providers are also starting to understand federal law on price discrimination
practices to third party payers. A few fines and they will follow the law.
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Non-profit hospitals such as CMH are in such a financial bind and have
been
for some time now. We are fortunate in our community to have the
generousity of citizens to contribute capital funds to support our
local
hospital and creative leadership to explore new and innovative ways to
remain successful.
It bothers me that the focus of the efforts Paul describes is on the
providers without addressing the other aspects of the system that is
horribly unbalanced.
Kathy
Response
In the past I have focused on the
insurance companies and it should be very clear to most that I have no love for
their practices and government endorsed monopolistic practices. I was simply passing
to the group the article for discussion because it moves us one step forward,
with many steps to follow, in an effort to make healthcare affordable to all.
It is also my understanding and study that
the art of healthcare pricing is not nuclear science. They are based on
CPT codes (The procedure) copyright American Medical Association and RVU’s
(Relative Value Unit). When rates are multiplied
we have the price. There are companies who for $400 will make up a custom
price list for most if not all providers. There are books available which
provide the codes, such as, 99211 “Office visit, established patient”
which has an RVU of .57 and a 2004 Medicare rate of $21.00 The code 99215 has
an RVU of 3.19 and a Medicare rate of $119. Without boring you further
books are available to list the prices paid, Medicare rates which are based on
actual data and formula’s. The problem is that only the big guys
have the computers and the data base to follow the formula for pricing and we
must rely on the fact that we consumer are getting the right price or fair
price based on the standards for the industry.
Paul Double
