Oct 20, 2014 | Health Navigator
The Wall Street Journal explored the health care insurance concept of Reference Pricing.
“The employee or enrollee can select any hospital or clinic but must pay the difference between the contribution limit and the actual price.”
“Reference pricing serves as a reverse deductible. Rather than the patient paying up to a defined limit and then the insurer covering the remainder, the insurer pays up to a defined limit and the patient pays the remainder. This has the remarkable feature of exposing the patient to the variation in prices for treatments that are above deductible thresholds. And the patient’s contribution isn’t limited by an annual out-of-pocket maximum.”
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Oct 19, 2014 | Health Navigator
The LATimes vignette noted “My coverage from Blue Cross Blue Shield of Illinois is exempt from the new limits because it predates the ACA, but it still has annual spending caps. The limits are $10,000 for services by providers in the plan’s network and $20,000 for out-of-network services. As a Blue Cross Blue Shield representative patiently explained to me, however, the out-of-network limit isn’t really a limit. When a customer reaches that amount, the insurer will still pay only the standard out-of-network share. That’s why my plan covered only 50% of the $54,755 charged by Tristate Care Flight to ferry me (by helicopter) from a car wreck in Quartzsite, Ariz., to a hospital in Phoenix. If Tristate wanted to bill me for the other half, the representative explained, it was free to do so.
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Updated on Jun 30, 2022 | Health Navigator
The New York Times article noted “Restricting consumers to a fixed network of doctors and hospitals, called in-network coverage, helps keep costs down, and for the first year, none of the 16 insurance companies in New York’s exchange deviated from that model.”
“Advocates for consumers had lobbied hard for out-of-network coverage, saying that some patients needed more choices, particularly since the networks are being kept small to further reduce costs. Under the current in-network system, someone who lives part of the year out of state, or a student at a college out of state, are not covered while they are away, except for emergency care.”
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Updated on Jun 30, 2022 | Health Navigator
A Kaiser Health news story noted “Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.”
“A 2011 GAO report sampling data from a handful of states before the health law took effect found that patients were successful 39 to 59 percent of the time when they appealed directly to the insurer. When appealing to a third party (such as the state insurance commissioner), patients also were often successful in getting the service in question – winning as many as 54 percent of such decisions in Maryland, for example. ”
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Updated on Jun 30, 2022 | Health Navigator
“Though the views were spectacular, the cardiac arrest team could not get there as quickly as it could to the regular wards.”
The New York Times article asked the questions “What is going on here? Is This a Hospital or a Hotel?”
“The Henry Ford health system in Michigan caused a stir after it hired a hotel industry executive, Gerard van Grinsven of the Ritz-Carlton Group, in 2006 to run its new hospital, Henry Ford West Bloomfield. There are some medical arguments for the trend — private rooms, for example, could lower infection rates and allow patients more rest as they heal. But the main reason for the largess is marketing.”
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The Wall Street Journal explored the health care insurance concept of Reference Pricing.
