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  • LivingAlmostLarge
    started a topic Insurance companies

    Insurance companies

    DH's company switched to a 3rd party company but kept aetna. I'm a little confused how this is a savings. What is the benefit? All I know is that everyone I call keeps telling me they don't take Meridian health now but when I explain it's still aetna they tell me to call and ask about being in network. I am spending a ton of time calling and figuring out whose in network and it's still everyone.

    Do most people have the regular insurance like blue cross blue shield? Or do people usually have 3rd party? This is really difficult.

  • disneysteve
    replied
    Originally posted by jhonpaul View Post
    Every day they work to make the system easier and more convenient for our customers.
    I always say not to feed the trolls or respond to spam but this is too funny. The idea that insurance companies "work to make the system easier and more convenient". You need to be taking some serious drugs to believe that.

    Leave a comment:


  • jhonpaul
    replied
    It is really a good idea that you have posted about the blue cross insurance.many would purchase Blue Cross insurance for hospital this made it cheaper to get health insurance through a job than by other the tax break for employer-sponsored health insurance is worth more to people ,well aetna is a good company to help them make decisions about their health care and their health care spending. Every day they work to make the system easier and more convenient for our customers.

    Leave a comment:


  • TexasHusker
    replied
    Originally posted by disneysteve View Post

    You do realize that post was written by some probably spammer in Bangladesh.

    As for the emu, he's a little odd.
    Yeah I like the lizard better although someone told me his native language is actually Yiddish.

    Leave a comment:


  • disneysteve
    replied
    Originally posted by TexasHusker View Post

    I love their commercials. Do they write health insurance?
    You do realize that post was written by some probably spammer in Bangladesh.

    As for the emu, he's a little odd.

    Leave a comment:


  • TexasHusker
    replied
    Originally posted by Radshaw8 View Post
    My most favorite insurance company is Liberty.
    I love their commercials. Do they write health insurance?

    Leave a comment:


  • Like2Plan
    replied
    Has it gone any smoother since you have been on this new medical coverage for a few months?

    Leave a comment:


  • Radshaw8
    replied
    My most favorite insurance company is Liberty.

    Leave a comment:


  • LivingAlmostLarge
    replied
    Maybe but it's definitely cheaper than the way the US system works now.

    Leave a comment:


  • creditcardfree
    replied
    Originally posted by TexasHusker View Post

    Things used to be fairly transparent in the pre-Medicare days. You went to the doctor, you paid your bill. Just like going to the grocery or a local restaurant. But when Medicare came into being, a gigantic "third party payor" injected itself into what was once a free-market economy. Instead of the patient paying their doctor bill, Medicare decided that IT would pay the doctor directly, and in that process, they would establish their own fixed fee schedule for all providers. That sounds really good on paper, but the fee schedules were (and are) woefully inadequate. Yet the providers (most of them) had to take Medicare because it represents so many patients.

    So, providers did what any other business person would do: They raised their rates to all of their OTHER patients to make up the difference. This is called "cost shifting", but in reality, it is "charge shifting." In the hospital system I used to work for, Medicare patients accounted for 65% of their business, but only about 18% of their revenue. So to make up the difference, the other 35% of the patients are charged 3-4-5 times what they should be.

    And in response to that, insurance companies eventually said "hey wait a minute, you're screwing us and our insureds" (and that would be true). So the insurance companies then developed THEIR OWN fee schedules for the providers to protect their insureds.

    Was Medicare a bad idea? On the cover, no. Senior citizens need some sort of medical care safety net. But it should have been more of a "major medical" insurance that covers hospital stays and perhaps prescriptions over a certain annual dollar amount. Not dissimilar to your homeowners insurance. When Medicare decided to get involved in routine doctor visits and prescription medications, the entirety of health care finance in the U.S. changed, and it hasn't been for the better.

    Generally, when the government inserts itself as a guarantor or payor of a massive amount of a segment of our economy - home loan guarantees, college loan guarantees and grants, and health care - the markets eventually get completely out of balance and things unravel: The housing crash of 2008 was in fact due to loose lending - zero down mortgages, etc. - but the dirty little secret is the Congress actually legislated various initiatives years earlier to loosen home loan requirements, and in fact REQUIRED lenders to follow along.

    College costs are skyrocketing because there is a market imbalance created by Uncle Sam: The government, through its various grants and loans, has removed the student from the payor equation. Uncle Sam IS the payor (at least for the 4 years of school). So the universities are saying "fine then, no one knows what it should cost, and no one cares...let's increase tuition by 10% and build a new stadium." Fast forward 4 years, and you've got a bachelors degree with $100K in debt, and no real way to pay it back.
    Well said. Those wanting single payer just don't understand the influence the government, and the laws they enact, has on various programs in this country that in the end actually cost all of us more money. I was just explaining the student loan issue to my daughter the other day.

    Leave a comment:


  • TexasHusker
    replied
    Originally posted by LivingAlmostLarge View Post
    Interesting how it all works. I wonder how much more transparency can be had under this non-socialized system?
    Things used to be fairly transparent in the pre-Medicare days. You went to the doctor, you paid your bill. Just like going to the grocery or a local restaurant. But when Medicare came into being, a gigantic "third party payor" injected itself into what was once a free-market economy. Instead of the patient paying their doctor bill, Medicare decided that IT would pay the doctor directly, and in that process, they would establish their own fixed fee schedule for all providers. That sounds really good on paper, but the fee schedules were (and are) woefully inadequate. Yet the providers (most of them) had to take Medicare because it represents so many patients.

    So, providers did what any other business person would do: They raised their rates to all of their OTHER patients to make up the difference. This is called "cost shifting", but in reality, it is "charge shifting." In the hospital system I used to work for, Medicare patients accounted for 65% of their business, but only about 18% of their revenue. So to make up the difference, the other 35% of the patients are charged 3-4-5 times what they should be.

    And in response to that, insurance companies eventually said "hey wait a minute, you're screwing us and our insureds" (and that would be true). So the insurance companies then developed THEIR OWN fee schedules for the providers to protect their insureds.

    Was Medicare a bad idea? On the cover, no. Senior citizens need some sort of medical care safety net. But it should have been more of a "major medical" insurance that covers hospital stays and perhaps prescriptions over a certain annual dollar amount. Not dissimilar to your homeowners insurance. When Medicare decided to get involved in routine doctor visits and prescription medications, the entirety of health care finance in the U.S. changed, and it hasn't been for the better.

    Generally, when the government inserts itself as a guarantor or payor of a massive amount of a segment of our economy - home loan guarantees, college loan guarantees and grants, and health care - the markets eventually get completely out of balance and things unravel: The housing crash of 2008 was in fact due to loose lending - zero down mortgages, etc. - but the dirty little secret is the Congress actually legislated various initiatives years earlier to loosen home loan requirements, and in fact REQUIRED lenders to follow along.

    College costs are skyrocketing because there is a market imbalance created by Uncle Sam: The government, through its various grants and loans, has removed the student from the payor equation. Uncle Sam IS the payor (at least for the 4 years of school). So the universities are saying "fine then, no one knows what it should cost, and no one cares...let's increase tuition by 10% and build a new stadium." Fast forward 4 years, and you've got a bachelors degree with $100K in debt, and no real way to pay it back.



    Last edited by TexasHusker; 01-17-2019, 09:10 AM.

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  • LivingAlmostLarge
    replied
    Interesting how it all works. I wonder how much more transparency can be had under this non-socialized system?

    Leave a comment:


  • disneysteve
    replied
    Originally posted by LivingAlmostLarge View Post
    I hate aetna. I don't like the network. I don't like how many less dr there are. It's annoying.

    DS is this common?
    This is very much a regional thing. Aetna (or any other company) might have a huge network in one area and a very small network in another. It is somewhat influenced, I suspect, by how large their patient population is in that area. The bigger their footprint, the more important it is for providers to sign on if they want to capture those patients. In my practice, we took almost everything but there were a few plans we didn't take because their reimbursement wasn't very good and they weren't big players in the area. By not signing a contract with them, we weren't really sacrificing anything.

    Leave a comment:


  • TexasHusker
    replied
    Originally posted by LivingAlmostLarge View Post
    No it stayed with Aetna but someone else is the the 3rd party and we are still on a PPO with Aetna network. I hate aetna. I don't like the network. I don't like how many less dr there are. It's annoying.

    DS is this common?
    Aetna would still have to be the administrator, as they do not lease their PPO network to other administrators, and for several reasons. CIGNA is the only administrator that leases out their network to third parties, and that is on a very limited basis.

    The best you can do is to have your employer (the benefits department) lean on Aetna to recruit more providers for their network. It is highly likely that if their network is lacking, Aetna is not offering satisfactory reimbursements to the providers. And they will not typically pay more to one provider for the same service as another provider. For one, they cannot successfully administer this, and two, providers talk.

    So...let's say Aetna has 50 OB/GYNs in their network in your area, but there are 20 OB/GYNs that do not participate. Aetna looks at it as "we have 70 percent of the providers". To get the other 20, they would likely have to increase their reimbursement schedule for all 70, which would cost your employer a lot of money. So Aetna is very unlikely to capitulate.

    Last edited by TexasHusker; 01-16-2019, 11:58 AM.

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  • LivingAlmostLarge
    replied
    No it stayed with Aetna but someone else is the the 3rd party and we are still on a PPO with Aetna network. I hate aetna. I don't like the network. I don't like how many less dr there are. It's annoying.

    DS is this common?

    Leave a comment:

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