Skip to comments.Hospitals Plot the End of Insurance Companies
Posted on 03/27/2014 10:13:38 AM PDT by Star Traveler
The problems with the implementation of the Affordable Care Act may be masking another major change in the way health care is delivered to U.S. consumers, experts believe.
At a conference in Washington on Thursday, health care and business professionals said that theres an increasing trend in the industry toward cutting insurance companies out of the process entirely, as large, regional hospital systems move into the insurance business.
Dr. Kenneth L. Davis, CEO and president of Mount Sinai Health System, the largest health care provider in the state of New York, said that starting next year, Mt. Sinai will begin offering its own Medicare Advantage plan. It will look for other opportunities to bring premium payments directly into the hospital system, rather than filtering them through insurance companies.
Davis said he expects organizations similar to his to move in the same direction. Inevitably the large systems are going to move to take part of the premium dollar, he said.
(Excerpt) Read more at thefiscaltimes.com ...
Its probably good. Depends on the checks and balances. Insurance companies sure don’t have our best interest in mind.
I was wondering when they would start this....................
Imagine, paying the hospital, in advance, for their services in case you need them................
Cuts out the middleman. Huge profit incentive for the hospital.
Not exactly a recipe for success, but the Insurance execs that Obama scammed probably didn’t see that one coming
The law of unintended consequences can be a bitch
If they did, they wouldn’t have allowed themselves to be cut out of the system for a quick profit.
Considering that insurance companies have driven up the cost of doing business in healthcare, I am all for this.
I read elsewhere a few months ago that solutions like this will force people to travel less for fear of getting hurt while being too far away from their covered hospital.
How do they answer that for HMO-type plans that have limited coverage areas, right now?
Sounds to me like the push is now full on to cut out insurance companies and go straight to single payer, i.e., Government, which was always the leftist intent from the get-go.
It may be ... simply ... the hospitals looking out for their own well being. And from their own standpoint, it does make a lot of sense. From the consumer standpoint, I just don’t know.
Still, these costs are offset somewhat based on your group. It's hard to say what the concept of "group" would be at a hospital-centered plan, if at all. Your "group" will be people who live in the vicinity of the hospital, without any other health, age, or occupational considerations taken into account?
My wife is a nurse working for an insurance company. She is paid to evaluate insured members fresh out of the hospital with the goal of preventing any repeat visits. The insurance company would much rather spend $5,000 on rehab and rehab equipment, for example, than have their member return for another $60,000 hospital visit. She sometimes seems to be the only person reviewing the total list of prescriptions to check for adverse side affects or harmful drug interactions.
Insurance companies help to control costs. Sometimes that involves - gasp! - rooting out fraud. Yes, there are people who go to hospitals with false ailments to get drugs, or who seek a doctor’s justification to collect SS disability. She saw that often while working as a nurse in a large local hospital.
Obamacare was never meant to be the ends, only the means.
You’re right. Seems like the insurance companies help build the scaffold thinking someone else would hang. Now they don’t like what they’re seeing.
Liberty and the free market is the way to go.
Insurance companies would wind up offering popular catastrophic insurance for peanuts. Consumers would pay much less because insurance/government/most-bureaucracy would be cut out of the equation. With some tort reform, costs would plummet even further.
Case in point: Doctor's today that have opted out of dealing with any insurance company.
I should add that as a nurse in a hospital, she often heard doctors discussing what the state’s medicaid program would pay before deciding on what was ‘wrong’. In one case, they decided to replace both knees on a woman with knee pain. The woman was 4’11” tall and weighed 300 lbs...but Medicaid would pay for knees. What she needed was a diet! With her weight, the artificial knees were doomed before they ever were inserted.
I’ve got friends that work medical accounts payable. Many of the problems with our healthcare system start with insurance companies. The big problem is they’re cheap, they never want to pay the bill handed to them, so there’s this crazy high/low game AP has to play to get the money they want they increase the bill knowing the insurance company will pay only a fraction of it (and then send you a letter bragging about how much they “discounted” your bill). And that cheapness also causes them to deny treatment plans that will work because they’re expensive and there’s some other way cheaper method that almost never works but they want that to fail first. Played tag with that when my wife ruptured her achilles, about 1% it will regrow all by itself if you keep the foot immobile for about six weeks first, or you can fix it with surgery (which also takes about 6 weeks to recover from), they wanted to try the regrow, we didn’t want her in a cast for 3 months with the first half doing nothing; took a lot of phone calls and threats and a smart doctor to navigate their idiocy.
And in the end this all costs everybody money. Doctors and hospitals spend a lot of money arguing with insurance companies, who spend a lot of money saying no, and we get sicker requiring more expensive treatments while all this happens. If you ever really want to see how much insurance companies cost everybody next time you need treatment whip out your Visa instead of your insurance card, guaranteed the price drops by at least 50%, probably over 60%.
I think that's the role of a good insurance company...they can direct your dollars to where you want to go (or need to go, if you're away from home)...
Which is not to say that all insurers are equal, but I do not foresee a system of insular single entity hospital care/insurance provider collectives ending well for consumers OR their doctors...
Why can't we just have health savings accounts, free-market access to insurers (across state lines, etc.), and at least general information published about pricing for services? and a "cash option"?
Another impact: This could tremendously affect house values. Think it’s a big deal to find a house in a good school system? Imagine when you have to live near a good hospital, or go without?
I read a story some time back about a doctor who tried to do the same thing: have his clients pay him a monthly fee & he took care of them. The gov’t went after him for running an illegal insurance plan (I’ve forgotten what they actually called it). Anyway, he was prohibited from continuing because he wasn’t a licensed insurance company. These hospitals should proceed with care. (No pun intended.)
Since Medicare Advantage is going away as part of the ACA this administrator is so far behind the curve it isn’t even funny
As an insurance agent, the answers are already out there. HSA combined with a cat plan. People elect a % of their pretax income into a account with their name on it. If govt really can’t stay out they can mandate it. “Don’t say the obvious please” Their employers, church group, non profit, can negotiate a range of options from various providers. So if NAG’s (National Organization of Gals) wants a free pass to be whores they can pay their out of pocket costs for birth control and abortions with their HSA and their cat policy can be tailored to offer the in network discounts and coverage options. Gay men can work out their HIV/AIDS risks in this manner. Costs can be controlled via behavior. For example, everyone is at risk for cancer as it does not discriminate. You can make an argument for certain types of cancer such as breast for women and prostate for men and lung for smokers but if put cancer as one group it probably balances. AIDS on the other hand is contracted almost entirely based on behavior and is %99.9 preventable. Therefore, insuring AIDS and other STD’s should cost more as they are preventable.
As for heart diseases we can blame mainstream medicine and food companies and govt for lying and giving bad dieting advice for the last 50-70 years advocating low saturated fat high carb diets.
I’m now getting into politicized “science” so Ill stop now.
Bottom line HSA and Catastrophic plans.
Think Kaiser Permanente and all other forms of prepaid care or health maintenance organization that you have encountered in the past (PPO and HMO instead of insurance)
YES...I forgot “tort reform” on my “wish list”...
There was a TV news segment in these parts a few months back about turning annual medical checkups into small-group sessions for people with the same general health situations. It seemed like a possibly good innovation.
I'm all for clinic-style health care. If the hospitals took over insurance and offered a walk-in first come first served clinic option to their enrollees, that would be a step in a good direction.
For one year in the late 1960s, I was just making ends meet and depended on clinic-style medicine at hospital-run facility. It's the best medical care I ever had.
Some insurance companies are leaning into this already. I read somewhere recently that Humana is transitioning heavily and aggressively into the services side of the market.
It will be great when it works. Deadly when it doesnt.
Why deal with random insurance company _________ who may or may not pay you what you are owed. When you can cut them completely out of the picture and take those profits to pad your own with 1/100th the hassle.
I envision private hospitals that only serve members and accept no walk ins, that charge a monthly fee similar to what health insurance does, but it's insurance but a club fee, with free healthcare being simply one of the benefits of the club.
I’ve known people who worked in management at insurance companies. They tell stories of being told to reject a certain percentage of claims just to see if the patient will pay them instead.
I list out all my medications and run them through through an online "drug website" which does checking for interactions. Usually you will see there are interactions, but I guess that unless it's severe, some interactions are manageable.
Also, I have an app on the iPad which will do that. I suppose that the doctor has those computer programs on his terminal that does that, too. He writes out my prescriptions right in the examination room with me and "clicks" to send it directly to the pharmacy. The pharmacy also will have programs to check interactions, so I guess, from what I've seen in my case, it's covered all the way around.
you could have agreements between hospitals that each would take the others members similar to how colleges have agreements to allow the children of employees to attend tuition free often have agreements with other colleges to take their employees kids in exchange.
Until recently I didnt have prescription coverage. I was paying $120 a month for one of my wifes prescriptions at the cash price.
Now the insurance company says the charge is $671 of which I pay a $80 copay.
locally... the poor use the ambulances for a free ride to that side of town.
IOW you will be enslaved to a medical plantation.
Slave because trains only go to government appointed stations.
slave because only quasi government bureacrats can offer life saving medical care.
You are nothing more than a tax serf.
If it does work well, count on the government to make it untenable.
There are lots of attempts by doctors to open low-cost non-insurance clinics year after year...and it is seldom the finances of the medical care that causes them to fold.
Insurance was never meant to provide free medical care and medicine! Insurance was suppose to be for if something catastrophic” happened.
I have no idea how that notion was somehow lost.
You are probably screwed.
For the longest time, and way before Obamacare, it seems one issue with healthcare has been whether the doctors or the insurance companies are deciding what the best medical procedure or answer is.
What a wonderful idea. I am sure hospitals cannot WAIT to be run by the federal government.
The hospital is NOT cutting out the insurance company, the hospital is setting up a subsidiary that will be an insurance company. Same system, just both entities owned by the same holding company.
This could be great.. it could reduce costs, make payments easier, etc.
Or the opposite could be true: you could end up with your medical provider and your insurer in bed together, neither having any incentive to cut costs, etc.
Exhibit A: the mud-slinging eye-goughing insult-throwing groin-kicking slap-fight currently going on here in Pittsburgh between UPMC and Highmark BC/BS.
I haven’t seen that Medicare Advantage would go away. That’s Medicare “Part C” - which takes the place of — Part A, Part B and Part D. You either have Part C - or - you have the other three together.
Now ..., I’ve got Part A, Part B, Part C - and - Medigap (Medicare Supplement Insurance) — which covers 100% of anything and everything. I have nothing out-of-pocket to pay on doctors, hospitals, labs, X-rays, equipment, rehab or anything - not even any deductible. I would rather have that than Medicare Part C.
But, again, who said that Part C was disappearing?
Here’s some info on that part of Medicare ...
When you get to Medicare age, then get what I have in Post #45, and you will be well covered.
hospitals don’t either.
As an insurance agent a med supp is superior to Medicare Advantage. Just make sure before you go on Medicare you already have relationships with key doctors such as your GP,Cardio,Endo etc.
They’ve got a hard-coded link to mine - and the bottom line result is I pay no deductible, no copay, no anything - just my premium.
I’ve always thought that a company like Wal-Mart would be what revolutionizes medical CARE. I thought a company that knows how to bring low cost goods to every corner of the nation would somehow figure out how to put urgent care or walk in clinics at affordable prices to all their stores. Much like they do with the eye glass stores.
BUT, the system is so irredeemably screwed up the system will collapse. And it has nothing to do with care. I am blessed with a good enough business and savings to cover all but the most catastrophic medical emergencies. No Obamacare for me. To those that had their plans cancelled and have deal with this mess I am sorry for you. I am sure eventually it will be a criminal offense NOT buying obamacare approved insurance and I will be threatened with prison time but until that day comes I’ll keep as far away from Obamacare as possible.