As expected under Obamacare: Insurance Exchange Premiums Through The Roof

[nate]

That's interesting, and a bummer, 'cause obviously it would be best if this actually worked out.

 

What is it that this article and stuff like the following links aren't sharing with us?

 

http://www.coveredca.com/news/PDFs/SilverPlanRatesChart.pdf

http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf

 

I think it's important that as much information as possible is available, so what are they not telling us here?

 

Are you talking about fully comparable plans? If so, that's a double bummer.

 

No, that is the problem.  Under ACA, plans have insane amounts of mandates that are very expensive that many of us will never need.  Since we are forced to cover them we must charge for them.  I would say about 15% of the people currently paying for individual health plans will receiver better, more affordable care under the "Affordable Care Act."  The other 85% will pay more for the same.

 

It goes beyond just individual and small group plans.  Everyone here can expect to pay much more for their health insurance by the end of 2014.  Higher end plans are being taxed to pay for the cheaper ones, so teachers, and other companies that give great health benefits to their employees are being penalized.  Companies won't absorb that cost, the insured will.

[RallyMo]

No, that is the problem.  Under ACA, plans have insane amounts of mandates that are very expensive that many of us will never need.  Since we are forced to cover them we must charge for them.  I would say about 15% of the people currently paying for individual health plans will receiver better, more affordable care under the "Affordable Care Act."  The other 85% will pay more for the same.

 

It goes beyond just individual and small group plans.  Everyone here can expect to pay much more for their health insurance by the end of 2014.  Higher end plans are being taxed to pay for the cheaper ones, so teachers, and other companies that give great health benefits to their employees are being penalized.  Companies won't absorb that cost, the insured will.

 

Good deal. Thanks for the reasonable response. I knew that'd be possible. Hopefully this works out but that doesn't seem too encouraging.

 

Our health system and its structure are screwed up beyond belief. If we could just blow the thing up and start from scratch it'd be best.

[mtangelsfan]

I think that is the only thing that would actually work at this point Rally, sadly

[RallyMo]

Yep.

 

...and that's an impossibility.

 

It kills me that other nations with relatively far fewer "resources" have better health outcomes (due to many, many differences in inputs and processes) than what we see here and for far less money. It really blows my mind.

[mp170.6]

Vegas Halo Fan might enjoy this because of his Oklahoma roots, but I think everybody would benefit.

 

A group of doctors in Oklahoma opened a surgery center with the least amount of overhead possible.  They have no administrators and the doctors themselves handle the scheduling.  The nurses answer phones and handle maintenance.  They do something entirely unprecedented by posting the prices of surgeries online.  They are also unique in that they accept cash and credit cards only.  No insurance accepted and yet people are flocking there in droves -- to the point they are expanding the facility to accommodate more people. 

 

In many cases, the surgery prices are cheaper than what you would pay in co-pays and deductibles to your insurance company. 

 

Surgery prices:  http://www.surgerycenterok.com/pricing.php

 

This video about the Surgery Center of Oklahoma is well worth 7 minutes of your time.  

 

[nate]

It would be nice if the government, both state and federal, would stay out of it.  These companies are competing for business but they are extremely hampered by having to follow such strict guidelines and mandates.

 

Currently, pre ACA rates are all over the board depending on which state your reside.  For example Arizona has something like 28 mandates for health insurance, New Jersey has over 50.  Rates in those States reflect that.  Rates in NJ are ~35% more than Arizona.

 

Meanwhile, people in AZ are more healthy than in NJ, I know that doesn't all have to do with the health coverage but the more mandates aren't exactly making a difference.

 

As with everything else, the politicians are so detached and clueless with what actually works or would help the people.  There are times where the state insurance commissioners are having to enforce laws that are either impossible to enforce or ridiculously expensive for the state and for us and never really reaches the customer in the first place.

[fan_since79]

For those of you that don't know, Rally is a Cal- Berkeley grad.  And if you can imagine a large group of people standing together, look to the far left.  That's where Rally would be standing.

I knew he wasn't conservative, but far left??? He seems too reasonable for that.

[mp170.6]

As with everything else, the politicians are so detached and clueless with what actually works or would help the people.  There are times where the state insurance commissioners are having to enforce laws that are either impossible to enforce or ridiculously expensive for the state and for us and never really reaches the customer in the first place.

 

The Obamacare folks made it illegal for doctor-owned facilities -- like the one in the video -- to exist if they plan to accept government money (i.e. Medicare).  Nevermind the fact they are 10x cheaper than hospitals, Obamacare caved to the lobbyists hired by the hospitals. 

 

Even worse, insurance companies want nothing to do with places like the Surgery Center of Oklahoma. 

 

There's rampant collusion between hospitals and insurance companies to keep costs high. 

[fan_since79]

I recently read an article in the L.A. Times about a woman who took her child to the emergency room for a minor dog bite. It was after hours and the ER was the only place open.

 

The kid didn't even need stitches. The bill was $1721 and her insurance only covered a small fraction of it.

 

That's absurd.

[nate]

The Obamacare folks made it illegal for doctor-owned facilities -- like the one in the video -- to exist if they plan to accept government money (i.e. Medicare).  Nevermind the fact they are 10x cheaper than hospitals, Obamacare caved to the lobbyists hired by the hospitals. 

 

Even worse, insurance companies want nothing to do with places like the Surgery Center of Oklahoma. 

 

There's rampant collusion between hospitals and insurance companies to keep costs high. 

 

Your last line is idiotic.  Hospital bills cost us tons.  We do everything we can to educate our customers to avoid the hospital unless it is necessary.  One of the biggest problems we face is that our customers run to the ER with any issue they have instead of consulting with their doctor or going to urgent care.

 

The fact is, Obamacare was lobbied by the hospitals and doctors.  They are going to make a killing.

[mp170.6]

Your last line is idiotic.  Hospital bills cost us tons.  We do everything we can to educate our customers to avoid the hospital unless it is necessary.  One of the biggest problems we face is that our customers run to the ER with any issue they have instead of consulting with their doctor or going to urgent care.

 

The fact is, Obamacare was lobbied by the hospitals and doctors.  They are going to make a killing.

 

Then why do insurance companies pay more than Medicare for the same procedures? 

 

Why won't insurance companies do business with low cost providers like the group in Oklahoma?

[mp170.6]

I recently read an article in the L.A. Times about a woman who took her child to the emergency room for a minor dog bite. It was after hours and the ER was the only place open.

 

The kid didn't even need stitches. The bill was $1721 and her insurance only covered a small fraction of it.

 

That's absurd.

 

I felt dizzy and had slurred speech after exercising one night.  It cleared up on its own, but I went to the ER anyway as a precautionary measure.  They did a CT scan of my head and basic bloodwork.  I wasn't even examined by an MD, but rather his Physician's Assistant.  No medications given, no procedures. 

 

Total cost for two hours in the ER = over $4000. 

[NJHalo]

The opposite has been happening.

They are able to charge lower prices because they aren't dealing with insurance companies for hours on end, and they don't need extra office employees to handle insurance claims. They also have more time to spend with patients.

This is true in my business. My company manages IV programs for Lyme Disease specialists, and NONE of them participate. They are all out of network, and the girl a the front desk just issues a receipt.

[nate]

Then why do insurance companies pay more than Medicare for the same procedures? 

 

Why won't insurance companies do business with low cost providers like the group in Oklahoma?

 

#1... you think us paying more is good for business???????  Medicare pays less because the government has contracts for each procedure that they will not pay any more for.  Insurance companies do not have the same leverage.

 

#2... malpractice.  Insurance companies will pay the bills at low cost providers like the ones in OK if the plan is an indemnity or straight PPO plan.  If the plan has networks we most likely would not have them in network because there is a very big vetting process that goes with each provider, including contractual rates that are lower than their normal rates, also malpractice insurance, certifications, etc.  If we recommend a doctor like that and they screw up a surgery, we are just as liable as the provider is.

[Vegas Halo Fan]

Vegas Halo Fan might enjoy this because of his Oklahoma roots, but I think everybody would benefit.

 

A group of doctors in Oklahoma opened a surgery center with the least amount of overhead possible.  They have no administrators and the doctors themselves handle the scheduling.  The nurses answer phones and handle maintenance.  They do something entirely unprecedented by posting the prices of surgeries online.  They are also unique in that they accept cash and credit cards only.  No insurance accepted and yet people are flocking there in droves -- to the point they are expanding the facility to accommodate more people. 

I looked at the video partly for the concept, but also to see if I know any of the doctors involved (I don't).

 

I am very familiar with Integris Health Care, the company that runs Baptist Medical Center, the hospital used for cost comparison in the video. I did some of my nursing school clinicals at that hospital on their orthopedic unit. Integris is the epitome of "profit first" health care companies. When they took over Baptist, they immediately laid off about 15 percent of the nursing and support staff. Administrators weren't touched. When my hospital became a takeover target, Integris was first in line to try to get their tentacles on us. Fortunately, the people making the decision saw through their plans and went with a company who had no other hospitals in our area. Integris Baptist administrators (the top 18 of whom make an average of over $400K per year - and this is in a state with a median income far below what we see in the west) are constantly spouting off about "quality care", while repeatedly making decisions that make its delivery impossible. As far as "recovering costs", Baptist is located in northwest Oklahoma City, which is relatively affluent compared to the rest of the metro area. Most of the uninsured go to the University of Oklahoma hospital near downtown. This is not to say that Baptist never has to eat a bill, but their percentage of uninsured patients is far less than most of the other hospitals in the area.

[Spirit]

I think you're a bit overboard there, but alright...

 

I'm giving nate a link to that. It's the only information we have here at the time and since we're having this discussion I figured I might as well ask. He can read it if he wants to and you can act like you did if you want to. That's your choice. I'm not being an asshole and I'm not asking you anything at all. I know better than to do that.

 

I'm genuinely more or less asking where those rates differ from what he's seeing and if he's allowed to talk about it I'm sure he'll have no problem doing so. Isn't it possible that the rates he sees in his company database are at the high end of those available in the exchange and that they aren't reflective of those at the cheaper end of the spectrum? I have n

 

I'm not expecting any kind of deep reaching response honestly but since one can more or less look over that stuff in 5 minutes and get a general idea of what's being said, I figure Nate can do it and that I'm not entirely nutso or "adorable" for asking, especially since he wanted to join the conversation. This is especially the case since we are, after all, a group that has no problem spending 15 minutes looking at completely meaningless stats on Baseball Reference.

 

I apologize if I went overboard. 

 

Happy Birthday.

 

 

 

 

 

 

 

And I still think you're cute as a button.

[halobob]

Yes.

 

I believe Rally set this up as a deke. 

Well I got deked and opened up the 5 hole big time!

[Jay]

Premiums are only one side of the equation, on the other you have coverage and deductibles/copays.  In my case the total cost of insurance is higher because deductibles and copays are higher.

[nate]

Premiums are only one side of the equation, on the other you have coverage and deductibles/copays.  In my case the total cost of insurance is higher because deductibles and copays are higher.

 

Under ACA there will be four plans.  Bronze, Silver, Gold and Platinum.  Each having a better deductible/copay.  My rate comparisons were based on similar deducible plans.  Only differences would be mandates like required mental health benefits, contraceptives, boner pills, etc.

[mp170.6]

For those that are amazed about that Oklahoma clinic cutting prices by taking cash, you should know a. If you are paying cash, almost any medical facility will take 50-75% off "regular" prices if you make a deal ahead of time, b. all medical bills can be negotiated downwards substantially after the fact.

 

I already pay cash for medical stuff. 

 

The amazing part about the Oklahoma folks is they publish surgery costs on their website.  It is virtually impossible to negotiate prices BEFOREHAND at a hospital.  Pretty easy at a doctor's office.

[mp170.6]

Another doctor ditches all insurance and Medicare; posts prices online:

 

http://bangordailynews.com/2013/05/27/news/portland/south-portland-doctor-stops-accepting-insurance-posts-prices-online/

 

 

His prices seem reasonable too:

http://ciampifamilypractice.com/Our_Prices.html

 

 

Office Visit (brief)                                                                                     $50.00
    (one straight forward issue. i.e. cold, sinus infection, bladder infection, etc.)
          
Office Visit (regular)                                                                                $75.00
    (one issue of moderate complexity or 2-3 simple issues.  i.e. diabetes follow up, back pain, abdominal pain)

Office Visit (extended)                                                                             $100.00
    (multiple issues and/or a single very complicated issue requiring more time, counseling, and/or coordination of care with other doctors or hospital)

Complete Physical Exam                                                                         $150.00
    (comprehensive history and physical exam and review of labwork for preventive health maintinence)

Well Child Exam                                                                                        $150.00
    (age appropriate history and physical.  immunizations usually covered by state at no extra cost)

House Call                                                                                                    $200.00
    (for patients who are homebound or too sick to come to office.  extra charge could apply if longer travel required)

Nurse Visit                                                                                                    $20.00
    (for follow up of established problems such as blood pressure rechecks, etc. Results reviewed by doctor to modify treatment plan)

Telephone Consultation with the Doctor                                       $20.00
     (for established patients only who cannot come in for appointment who have questions they want to ask the doctor personally.  $20 for a conversation up to 10 minutes.  Additional minutes will be billed $10 for every additional 5 minutes, or fraction thereof.  We will not do telephone consultations on patients who have not been seen by the doctor in the past year)

Minor Surgery (w/o sutures)                                               $100.00-$150.00
    (i.e. drainage of abscesses/boils, shave biopsies without sutures.)

Minor Surgery (w/ sutures)                                                  $200.00-$250.00
    (i.e. removal of skin lesions which require stitches.  Follow up visit for removal of stitches is included)

Joint Aspiration/Injection                                                                    $50.00
    (cortisone injection of shoulder, drainage of ganglion cysts, etc.)

Ear Cleaning                                                                                                $30.00
    (flushing of ear to remove wax)

Ear Popper                                                                                                    $15.00
    (use of ear popper device to clear blocked Eustacian Tube)

Cryotherapy                                                                                                 $30.00
    (freezing of warts, skin tags, and some pre-malignant skin lesions)

Electrical Muscle Stimulation                                                              $30.00
    (LaserTouchOne device applied to spasmed muscles to treat pain)

Spirometry Testing                                                                                    $25.00
    (simple breathing test to evaluate lung function)

Nebulizer Therapy                                                                                      $25.00
    (inhaled treatment for asthma, bronchitis, emphysema)

Pre & Post Nebulizer Spirometry                                                         $40.00
    (breathing test before and after treatment to evaluate effectiveness of treatment and diagnose asthma)

EKG                                                                                                                     $25.00
    (measurement of electrical impulses of the heart)

Injections:
    
    Vitamin B 12                                                                                                    $10.00

    Toradol                                                                                                             $20.00

    Ceftriaxone                                                                                                      $20.00


Lab Tests:

     Hemoglobin A1C                                                                                            $20.00

     Urine Dipstick Analysis                                                                                $10.00

      PT/INR                                                                                                            $10.00

      Helicobacter Pylori                                                                                        $10.00
             (this fee covers collection of specimen.  lab fees are separate and can be billed to your insurance)

      Glucose                                                                                                              $10.00

      Urine Pregnancy Test                                                                                     $10.00
 

[nate]

Some of those prices are pretty high.  For example, a "well child exam" for my Daughter costs $120 before insurance is factored in.

[mp170.6]

Some of those prices are pretty high.  For example, a "well child exam" for my Daughter costs $120 before insurance is factored in.

 

Costs $120 where?

[nate]

Healthcare Partners down the street.

[mp170.6]

Healthcare Partners down the street.

 

Are those "retail" prices negotiated in advance with the insurance companies?