Question about American health insurance.

[PM Martin]

DO HMO's/PPO's negotiate doctor payments?
I understand that private for profit insurance does not usually pay what the provider requests.
Example: If the provider asked for $1,000, insurance may pay them $600 or so.
Do HMO's/PPO's work the same way or do they negotiate the costs ahead of time?

[sinkingfeeling]

1. Absolutely. If you want to see how badly Americans are being ripped-off

read this Time report: Bitter Pill: Why Medical Bills Are Killing Us

http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf

[Hoyt]

2. Just don't go out of network if you can avoid it. The out-of-network doc or hospital

can come after you for the difference between their charge and PPO/HMO's allowable. That can be substantial.

[TheKentuckian]

3. Of course. This is part of why the MRL is more of danger than a containment system.

To increase revenue the cartel is forced to allow more dollars to pass through and they can do that super easily because all they have to do is increase allowable charges and when (and if) they run out of room there then they can negotiate toward providers a tick or two and then play the allowable charges game again for a while.

The concept of a shell game should be within the perception range of most folks.

[Safetykitten]

4. Very nice post!

[PM Martin]

5. I see.

[Hoyt]

6. Except of course that puts their premiums higher than others in exchange and folks will move to

the lower premium insurers. So, that's not really feasible.

The beauty of the Exchanges -- although not as pretty as single payer -- are that now folks can look and see how one plan stacks up to others. Are you going to go with the plan with the highest premiums? I doubt I will.

[Safetykitten]

7. I want the one where you get THREE DOCTOR VISITS a year. What a deal!

[Hoyt]

8. That third visit might be one where they tell you without $10 million treatment you will suffer pain

[TheKentuckian]

9. Why would anyone expect that? This is a cartel with an anti-trust exemption that would have been

the very first thing ended if there was any actual expectation of market competition.

What you are talking about if a fairy tale to shut people up about the actual structure of health care funding in this country until either the cartel can't suck any more marrow from our bones at a tidy profit or the government can't absorb the difference between what folks can afford and what the cartel demands.

[Hoyt]

10. Yep, that's why rates are coming in much lower than expected. Your premise is flawed, because it

Last edited Fri Aug 2, 2013, 06:08 PM - Edit history (1)

won't work anymore. No insurer can jack up rates they pay and expect to remain competitive. It is more likely you will see just the opposite -- more pressure on providers, drug companies, etc., to give concessions.