SuchGreatBoring t1_j1setrq wrote
When in doubt, the answer is money. It's very difficult to maintain a small practice. Insurers make that even more complicated so they are forced to see our to larger groups.
chelleezz t1_j1slefl wrote
I’m in billing and this is exactly it
tmssX t1_j1vow2d wrote
My dumbass was trying to figure out how bring from Billings Montana made you an expert
JRZane t1_j1tjth4 wrote
Also a doctor and very familiar with billing. The entire managed care/commercial insurance driven reality focuses so much on efficiency that GPs are forced to adapted. There is a HUGE shortage of young GPs in the USA.
Here’s an example from psychology. Years ago, only psychiatrists conducted therapy and also prescribed medicine. Then psychologists became a credential profession to do just the therapy part (didn’t need to ALSO be a physician for the medicine rx). Then counselors came along and could do the therapy part without having to learn psych testing and evaluations. Now there are psycho-metricians that can administer tests and psychologists only INTERPRET the results. Basically insurances want clinicians to ONLY do the part of their job that requires the highest level of training. Anything under that is done by a lesser credentialed clinician. And it saves insurances tons of money that isn’t passed on to customers.
Did you know that in 2020, during a pandemic, Indep Blue Cross had its highest profit year EVER!?!? Think about THAT one….
In the medical field, we see the addition of Physicians Assistants (to be called Associates starting next week) and NP’s. Unfortunately I see this trend continuing….
OkBid1535 t1_j1u1qs6 wrote
Blue cross is such trash. They dropped our coverage numerous times over 3 years because we had automatic pay set up. And paid on time. Then at a dentist or dr appt being told “you have no coverage and have to pay in full.” Or a medical emergency with my 4yr old where she had to be hospitalized for 3 days. Hospital actively trying to kick us out cause we had no insurance and my husband fighting for 3 days with BCBS to reinstate our benefits. And the hospital staff shaking there heads saying “yeah this happens all the time..”
It boils my blood I’m not an isolated incident. That so many like me are paying astronomical amounts for health insurance, only to have all benefits stripped away the second we go to use them. Punished for paying in time or early. Make it make sense
JRZane t1_j1u8kj0 wrote
what year was this? What state was your coverage based??
regulation for this has improved over the past few years. specifically 2010 ACA and 2011 parity law made some huge improvements (pre-existing conditions, mandatory coverage for various services like mental health, catastrophic coverages, etc), its such a shame SOME (not mentioning names to make this political) politicians did their best to tear those laws down. If they just worked to IMPROVE instead of REMOVE we really could have been close to having a system that works.
An existing problem that still exists is that insurance is regulated state by state. I live in NJ and the same plan from Horizon BCBS costing $700/month for a couple (2500 deductible, $20/$50 copays) costs $1500 in Delaware with Highmark BCBS because of the difference in income-driven costs. We all know the best way to keep premiums down is to enlarge the pool of customers. One way the insurances ruin that strategy is to hack us into groups (not allowing cross-state plans).
While I see myself as socially liberal, the Democrats' incompetence has cost us progress as well. However finally allowing CMS to negotiate drug prices for Medicare/Medicaid should be a big improvement for some older and poorer folks.....or maybe Im being naive and the crooked PBM and insurance companies will find a way to sidestep that too....
Sorry, I can go on all day about this shit. drives me crazy.....
​
Edit: another rant: another thing people dont realize is their employer HR manager negotiates with insurance brokers for your plan. If you work for a company (especially smaller companies) with older employees op high-utilization folks (read: sicker), it WILL affect the cost of YOUR premiums. Working for a larger, younger company equals lower premiums.
OkBid1535 t1_j1u8per wrote
It’s based in NJ and has been consistently an issue since 2020
JRZane t1_j1ua074 wrote
obviously I dont know your issue, but there's something odd going on here. The only way a company can legally "drop" a customer mid-year (not during open enrollment ie. end of the benefit year) is bc of not paying the premium. Even then, there's a grace period where if a person catches up on premiums it's as if no lapse in coverage occurred. They also MUST send out letters stating premiums are behind and provide a deadline date.
At my practice we get these letters all the time. like, weekly. Patient A has been coming in and we receive a letter stating "Patient A hasn't paid their premium, if its not paid by Date X claims from (date to date) won't be paid."
Please dont read this as not believing you, what im saying is knowing the regs a little bit gives you some leverage so you aren't surprised as you mentioned. There are also programs to cover kids, even if you have reasonable financial means (CHIP), and it's backdated. So if your kid didn't have coverage starting Feb 1 and he/she I admitted into hospital Feb 15, CHIP will cover the costs 90 days PRIOR to claim. Most hospitals have a social worker that will help with application. Now, its a low-paying plan and they will still try and get you out quickly (hospital soperate in the red with CMS rates and need commercial plans to stay afloat), but you won't be on the hook for monster bills.
OkBid1535 t1_j1utvgy wrote
When we were in the hospital absolutely no one there was willing to work with us or discuss other options. No one even mentioned CHIP to us. We had NJ family care years ago but since priced out of it basically.
We again had auto pay set up and paid our premiums. We’ve had to pay hundreds and thousands out of pocket and certain appointments after finding out we’d lost insurance.
It’s been hell. And the worst part is, it isn’t just us. We’ve multiple self employed friends using BCBS, set up for autopay and same thing. Punished for paying on time and coverage is dropped. There was even a huge lawsuit circulating for people to sue horizon because it’s been getting so bad.
Babhadfad12 t1_j1uqkz3 wrote
> I live in NJ and the same plan from Horizon BCBS costing $700/month for a couple (2500 deductible, $20/$50 copays) costs $1500 in Delaware with Highmark BCBS because of the difference in income-driven costs.
What are income-driven costs? I have not seen differences that big between states.
https://www.kff.org/health-reform/state-indicator/average-marketplace-premiums-by-metal-tier/
> We all know the best way to keep premiums down is to enlarge the pool of customers. One way the insurances ruin that strategy is to hack us into groups (not allowing cross-state plans).
This was not because of “the insurances” by the way, this was upper middle class and pretend upper middle class people that forced this issue. White collar workers that worked for well funded and established businesses balked at their insurance premiums going up to pay for poor and unhealthy people.
People are, unfortunately, very tribal.
JRZane t1_j1uuc8y wrote
Most "marketplace" plans take into account income to determine how much insurance plans are subsidized. Each state determines their own scale. In NJ and DE, the scales are significantly inconsistent with one another. These numbers are made up, but just for illustrative purposes, a person making 100k in NJ may qualify for 25% subsidies while that same 100K qualifies for 5% subsidy in DE.
And to your other point about this being class driven, I have no doubt there was that type of mentality in there, sure. BUT it wouldn't have actually happened if it didn't benefit the insurance company. and it wouldn't have been ALLOWED to happen if legislatures had the good of all people in mind.
We have a mentality that in the USA that people who are poor and underserved are deservedly so, and that it is their own fault for being in that position in the first place. I can point to several social perspectives that boil down to that single factor. Its situation vs disposition phenomena at its finest.
Babhadfad12 t1_j1uxn7p wrote
> And to your other point about this being class driven, I have no doubt there was that type of mentality in there, sure. BUT it wouldn't have actually happened if it didn't benefit the insurance company. and it wouldn't have been ALLOWED to happen if legislatures had the good of all people in mind.
Possibly, health insurance companies are going to benefit regardless if everyone was required to purchase health insurance. Theoretically, it makes no difference to them if an employer is involved.
I just specifically remember people up in arms about removing employers from the equation and being dumped onto healthcare.gov where the risk pool would have caused them to pay more.
People are still upset at health insurance costing more than pre ACA, even though it covers a lot more (no benefit maximum, no denial due to pre existing condition, no underwriting for one’s specific health risks, etc.).
And of course, the fake religious “insurance” that is not really insurance or complaint with ACA had to be allowed, and that was not due to insurance companies.
KaliGracious t1_j1w1sxd wrote
Health insurance is a country is a fucking disaster. Let’s just start at that. It is insane that we cannot get politicians who will come in and fix this disaster. Republicans have absolutely NO solution for this problem and democrats barely know what they are doing.
This is what happens when you have politicians running a county. We need to get money the fuck out of politics.
JRZane t1_j1uwp0e wrote
also, regarding the "average" chart, have you seen a chart showing MEDIAN? this is clearly a situation of restricted range with some folks paying very little and some folks paying the higher end. sure the average may be $400, but that doesn't illustrate the difference between person 1 paying $10/month and person 2 paying $800.
IronSeagull t1_j1vrzha wrote
> And it saves insurances tons of money that isn’t passed on to customers.
The ACA requires insurance companies to spend 80% of premiums on benefits, so effectively any cost savings have to be passed on to customers. Customers won't see that in the form of a cost reduction because all they're really doing is slowing the rate of healthcare cost inflation. But that still saves the customer money compared to the status quo.
JRZane t1_j1vzwro wrote
sure. but there's also a thing called "creative accounting." that ACA rule also allows for deferments and other "deduction" type loopholes. I think its a good thing, but its not as simple as calculating ACTUAL revenue * .8
There are SO many things broken about our system. what upsets me is that we could fix them but we CHOOSE not to. See above posts about judging who "deserves" quality care.
Babhadfad12 t1_j1upej5 wrote
> Did you know that in 2020, during a pandemic, Indep Blue Cross had its highest profit year EVER!?!? Think about THAT one….
3.4% “profit” margin in 2021, 2.9% in 2020, 2.1% in 2018. And not really a profit margin since Independence Blue Cross is a not-for-profit so there are no owners to distribute profits to.
https://www.ibx.com/about-us/annual-reports
Managed care organizations (aka health insurance companies) have tiny profit margins in general. UHC has 6%, as an outlier, but the rest, Elevance, CVS, Cigna, Humana, Centene, Molina, etc all have 2% to 4% profit margins, year after year for a decade +.
Not really much juice left to squeeze there. The bigger profit margins are in pharmaceuticals, software vendors, equipment vendors, and doctor groups (which PE firms had noticed 10+ years ago).
JRZane t1_j1uvr5f wrote
as a business owner, I understand the importance of margins, but that marginal increase translates to them profiting 2.6BILLION dollars more than the previous year. My real point being this was during a pandemic. Sure, during typical years a 2-4% increase is a sign of good, lean management. but it's the same way flood insurance companies make more money during floods....it sure seems counter intuitive, no?
and keep in mind that increase also included the "cost sharing" programs where all copays were waived because they were making so much damn money apparently they felt guilty or were just concerned about blow back. I haven't seen any published figures about what they "waived" but Im willing to bet it'd bump that 2.6B up a bit if they weren't on the hook for it.....
https://news.ibx.com/independence-health-group-reports-2020-financial-results/
maybe im just cynical because I see it from clients perspective and see so many people struggling to access care to sustain a basic quality of life I believe in this country should be an inherent right. I dont believe healthcare should be attached to employment, and I do NOT believe in single-payer solution. (government OPTION.....maybe.)
Babhadfad12 t1_j1uwp9c wrote
> as a business owner, I understand the importance of margins, but that marginal increase translates to them profiting 2.6BILLION dollars more than the previous year.
Nominal profits are not comparable year to year, especially due to the decreasing purchasing power of the currency, aka inflation. Hence, it is most appropriate to use profit margins when comparing a business’s performance over time.
> Sure, during typical years a 2-4% increase is a sign of good, lean management. but it's the same way flood insurance companies make more money during floods....it sure seems counter intuitive, no?
Health insurance companies are kind of / not really insurance companies, which is why I think managed care organizations is a better term for them.
JRZane t1_j1uxc97 wrote
Just reading the report I linked.
"Independence Health Group, Inc., (Independence) the parent company of Independence Blue Cross, LLC, reported solid financial results for 2020 with total revenue of $21.8 billion, up $2.6 billion or 13.5 percent over 2019"
you could argue the same for profit margins too. If you want to get into depreciation, cash on hand, deferred losses, bad debt, real estate depreciation/appreciaiton. then those numbers Never mean anything at all. you're still getting lost in the numbers and missing my ACTUAL initial point. what you're saying is valid, but I believe your missing the forest for the trees here. good day, good luck. im out.
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