Healthcare. Yes this subject again.

[ucodegen]

MRIs are a limited resource.. with a limited number of machines. It is very hard for insurance to negotiate these down.

For HMO/PPOs it depends on whether you get to choose your own doctor or use a plan doctor on how much potential discount through the plan. Service may also suffer w/ the plan doctors.

In doing self-pay vs comparison of what I would normally pay for with insurance (including the monthly payment), self-pay easily wins. What ever savings there may be in negotiated fees for some services, easily gets eaten up in the insurance company’s overhead. I included what I would pay for dental. I have had to have considerable dental work (lost track of the number of crowns), to the point that I would have gotten close to busting the lifetime cap on some dental insurance plans. BTW before you jump in on it, the reason why I had to have so much dental work was because of a dentist, not because the lack of one.

The degree of discount on rates is largely a fallacy. An easy way to check would be to figure out how much is being paid in for a GP’s office using self-pay rates and then calculate out what the effective earnings would be (subtracting office overhead, support personnel wages and insurance, malpractice insurance). The numbers end up not working out for a large discount. I even ran this for my GP.

Why would GPs and groups like Scripts give discounts to cash payers? Maybe because they don’t have to carry overhead to manage the insurance on these. I don’t think ‘charity’ fits here, certainly when you are dealing with a client who can whip out the checkbook and cover a $3000 bill without breaking a sweat.

http://www.cbsnews.com/stories/2004/04/05/health/main610269.shtml

Paragraph 4-7 is interesting here, read all:
http://www.articlesbase.com/insurance-articles/cash-discounts-if-you-want-to-pay-less-at-the-doctor-ask-about-cash-discounts-624181.html

http://www.nctimes.com/business/article_392491ef-109a-5af6-b058-69172350df03.html

There is a field within an insurance company’s 10K/Q that you may want to look at. I don’t remember the exact name is, but it equates to the ratio of claims paid out vs premiums paid in. Usually this number is less than one. During the time between the premium being paid in and the claim being paid out, the insurance co has use of that money for investing.

[SK in CV]

[quote=ucodegen]
The degree of discount on rates is largely a fallacy. An easy way to check would be to figure out how much is being paid in for a GP’s office using self-pay rates and then calculate out what the effective earnings would be (subtracting office overhead, support personnel wages and insurance, malpractice insurance). The numbers end up not working out for a large discount. I even ran this for my GP.
…

There is a field within an insurance company’s 10K/Q that you may want to look at. I don’t remember the exact name is, but it equates to the ratio of claims paid out vs premiums paid in. Usually this number is less than one. During the time between the premium being paid in and the claim being paid out, the insurance co has use of that money for investing.[/quote]

It’s not a fallacy, it’s real. I just checked my summary of charges for 2008. My total charges were $3,884. My insurance (Aetna) paid $1,972.91, and I paid $170. Providers (for this year, coincidentally, it was 100% Scripps Clinic) took a discount of $1,741.90 or 44.8%. For 2009, the numbers are similar (total of $2827, insurance paid $1606, i paid $90, net discount of $1131 or 40%). I have no idea how the providers overhead and expenses are related to this issue. Those are mostly incurred regardless of cash payers or third party payers. (There would be some savings obviously if they didnt have to process all the insurance/medicare stuff.)

The term you’re looking for is loss ratio. The % of premium dollars that are paid directly for health care. It is always less than 1. If it was anywhere near 1, we wouldn’t need reform. That’s a huge part of the problem. In the late 80’s to early 90’s, when I did health care financing consulting for small medical groups and non-profit hospitals, (when capitations for primary care physicians was becoming common place) loss rations were in the very high 80’s to mid 90’s. (I remember one year when, i think it was Blue Cross, bragged about getting their loss ration below 90%) They’re now in the high 70’s to low 80’s and getting worse for consumers, better for insurance companies. All that extra profit is going directly to the bottom line of insurance companies. The system is irreparably broken.

Medical insurance is claims incurred insurance. Since most policies call for monthly or bi-monthly premiums, use of the premiums prior to payment of claims is not material as it is in life, disability or even professional liability insurance, where payment of claims are deferred.

[SK in CV]

[quote=ucodegen]
The degree of discount on rates is largely a fallacy. An easy way to check would be to figure out how much is being paid in for a GP’s office using self-pay rates and then calculate out what the effective earnings would be (subtracting office overhead, support personnel wages and insurance, malpractice insurance). The numbers end up not working out for a large discount. I even ran this for my GP.
…

There is a field within an insurance company’s 10K/Q that you may want to look at. I don’t remember the exact name is, but it equates to the ratio of claims paid out vs premiums paid in. Usually this number is less than one. During the time between the premium being paid in and the claim being paid out, the insurance co has use of that money for investing.[/quote]

It’s not a fallacy, it’s real. I just checked my summary of charges for 2008. My total charges were $3,884. My insurance (Aetna) paid $1,972.91, and I paid $170. Providers (for this year, coincidentally, it was 100% Scripps Clinic) took a discount of $1,741.90 or 44.8%. For 2009, the numbers are similar (total of $2827, insurance paid $1606, i paid $90, net discount of $1131 or 40%). I have no idea how the providers overhead and expenses are related to this issue. Those are mostly incurred regardless of cash payers or third party payers. (There would be some savings obviously if they didnt have to process all the insurance/medicare stuff.)

The term you’re looking for is loss ratio. The % of premium dollars that are paid directly for health care. It is always less than 1. If it was anywhere near 1, we wouldn’t need reform. That’s a huge part of the problem. In the late 80’s to early 90’s, when I did health care financing consulting for small medical groups and non-profit hospitals, (when capitations for primary care physicians was becoming common place) loss rations were in the very high 80’s to mid 90’s. (I remember one year when, i think it was Blue Cross, bragged about getting their loss ration below 90%) They’re now in the high 70’s to low 80’s and getting worse for consumers, better for insurance companies. All that extra profit is going directly to the bottom line of insurance companies. The system is irreparably broken.

Medical insurance is claims incurred insurance. Since most policies call for monthly or bi-monthly premiums, use of the premiums prior to payment of claims is not material as it is in life, disability or even professional liability insurance, where payment of claims are deferred.

[SK in CV]

[quote=ucodegen]
The degree of discount on rates is largely a fallacy. An easy way to check would be to figure out how much is being paid in for a GP’s office using self-pay rates and then calculate out what the effective earnings would be (subtracting office overhead, support personnel wages and insurance, malpractice insurance). The numbers end up not working out for a large discount. I even ran this for my GP.
…

There is a field within an insurance company’s 10K/Q that you may want to look at. I don’t remember the exact name is, but it equates to the ratio of claims paid out vs premiums paid in. Usually this number is less than one. During the time between the premium being paid in and the claim being paid out, the insurance co has use of that money for investing.[/quote]

It’s not a fallacy, it’s real. I just checked my summary of charges for 2008. My total charges were $3,884. My insurance (Aetna) paid $1,972.91, and I paid $170. Providers (for this year, coincidentally, it was 100% Scripps Clinic) took a discount of $1,741.90 or 44.8%. For 2009, the numbers are similar (total of $2827, insurance paid $1606, i paid $90, net discount of $1131 or 40%). I have no idea how the providers overhead and expenses are related to this issue. Those are mostly incurred regardless of cash payers or third party payers. (There would be some savings obviously if they didnt have to process all the insurance/medicare stuff.)

The term you’re looking for is loss ratio. The % of premium dollars that are paid directly for health care. It is always less than 1. If it was anywhere near 1, we wouldn’t need reform. That’s a huge part of the problem. In the late 80’s to early 90’s, when I did health care financing consulting for small medical groups and non-profit hospitals, (when capitations for primary care physicians was becoming common place) loss rations were in the very high 80’s to mid 90’s. (I remember one year when, i think it was Blue Cross, bragged about getting their loss ration below 90%) They’re now in the high 70’s to low 80’s and getting worse for consumers, better for insurance companies. All that extra profit is going directly to the bottom line of insurance companies. The system is irreparably broken.

Medical insurance is claims incurred insurance. Since most policies call for monthly or bi-monthly premiums, use of the premiums prior to payment of claims is not material as it is in life, disability or even professional liability insurance, where payment of claims are deferred.

[SK in CV]

[quote=ucodegen]
The degree of discount on rates is largely a fallacy. An easy way to check would be to figure out how much is being paid in for a GP’s office using self-pay rates and then calculate out what the effective earnings would be (subtracting office overhead, support personnel wages and insurance, malpractice insurance). The numbers end up not working out for a large discount. I even ran this for my GP.
…

There is a field within an insurance company’s 10K/Q that you may want to look at. I don’t remember the exact name is, but it equates to the ratio of claims paid out vs premiums paid in. Usually this number is less than one. During the time between the premium being paid in and the claim being paid out, the insurance co has use of that money for investing.[/quote]

It’s not a fallacy, it’s real. I just checked my summary of charges for 2008. My total charges were $3,884. My insurance (Aetna) paid $1,972.91, and I paid $170. Providers (for this year, coincidentally, it was 100% Scripps Clinic) took a discount of $1,741.90 or 44.8%. For 2009, the numbers are similar (total of $2827, insurance paid $1606, i paid $90, net discount of $1131 or 40%). I have no idea how the providers overhead and expenses are related to this issue. Those are mostly incurred regardless of cash payers or third party payers. (There would be some savings obviously if they didnt have to process all the insurance/medicare stuff.)

The term you’re looking for is loss ratio. The % of premium dollars that are paid directly for health care. It is always less than 1. If it was anywhere near 1, we wouldn’t need reform. That’s a huge part of the problem. In the late 80’s to early 90’s, when I did health care financing consulting for small medical groups and non-profit hospitals, (when capitations for primary care physicians was becoming common place) loss rations were in the very high 80’s to mid 90’s. (I remember one year when, i think it was Blue Cross, bragged about getting their loss ration below 90%) They’re now in the high 70’s to low 80’s and getting worse for consumers, better for insurance companies. All that extra profit is going directly to the bottom line of insurance companies. The system is irreparably broken.

Medical insurance is claims incurred insurance. Since most policies call for monthly or bi-monthly premiums, use of the premiums prior to payment of claims is not material as it is in life, disability or even professional liability insurance, where payment of claims are deferred.

[SK in CV]

[quote=ucodegen]
The degree of discount on rates is largely a fallacy. An easy way to check would be to figure out how much is being paid in for a GP’s office using self-pay rates and then calculate out what the effective earnings would be (subtracting office overhead, support personnel wages and insurance, malpractice insurance). The numbers end up not working out for a large discount. I even ran this for my GP.
…

There is a field within an insurance company’s 10K/Q that you may want to look at. I don’t remember the exact name is, but it equates to the ratio of claims paid out vs premiums paid in. Usually this number is less than one. During the time between the premium being paid in and the claim being paid out, the insurance co has use of that money for investing.[/quote]

It’s not a fallacy, it’s real. I just checked my summary of charges for 2008. My total charges were $3,884. My insurance (Aetna) paid $1,972.91, and I paid $170. Providers (for this year, coincidentally, it was 100% Scripps Clinic) took a discount of $1,741.90 or 44.8%. For 2009, the numbers are similar (total of $2827, insurance paid $1606, i paid $90, net discount of $1131 or 40%). I have no idea how the providers overhead and expenses are related to this issue. Those are mostly incurred regardless of cash payers or third party payers. (There would be some savings obviously if they didnt have to process all the insurance/medicare stuff.)

The term you’re looking for is loss ratio. The % of premium dollars that are paid directly for health care. It is always less than 1. If it was anywhere near 1, we wouldn’t need reform. That’s a huge part of the problem. In the late 80’s to early 90’s, when I did health care financing consulting for small medical groups and non-profit hospitals, (when capitations for primary care physicians was becoming common place) loss rations were in the very high 80’s to mid 90’s. (I remember one year when, i think it was Blue Cross, bragged about getting their loss ration below 90%) They’re now in the high 70’s to low 80’s and getting worse for consumers, better for insurance companies. All that extra profit is going directly to the bottom line of insurance companies. The system is irreparably broken.

Medical insurance is claims incurred insurance. Since most policies call for monthly or bi-monthly premiums, use of the premiums prior to payment of claims is not material as it is in life, disability or even professional liability insurance, where payment of claims are deferred.

[Nicole]

Doctors are a diverse group and I don’t think there is a common voice. I am a physician and would be thrilled to have a universal payer system. Currently there is way too much overhead in dealing with so many insurance companies. We’re already paying for the healthcare of the uninsured (through emergency care, disability checks to those whose disability could have been prevented, and community clinic subsidized by state/federal programs)so I don’t see why we don’t do it in a way that makes sense and would be cheaper (ie preventative care).

just my two cents….

[Nicole]

Doctors are a diverse group and I don’t think there is a common voice. I am a physician and would be thrilled to have a universal payer system. Currently there is way too much overhead in dealing with so many insurance companies. We’re already paying for the healthcare of the uninsured (through emergency care, disability checks to those whose disability could have been prevented, and community clinic subsidized by state/federal programs)so I don’t see why we don’t do it in a way that makes sense and would be cheaper (ie preventative care).

just my two cents….

[Nicole]

Doctors are a diverse group and I don’t think there is a common voice. I am a physician and would be thrilled to have a universal payer system. Currently there is way too much overhead in dealing with so many insurance companies. We’re already paying for the healthcare of the uninsured (through emergency care, disability checks to those whose disability could have been prevented, and community clinic subsidized by state/federal programs)so I don’t see why we don’t do it in a way that makes sense and would be cheaper (ie preventative care).

just my two cents….

[Nicole]

Doctors are a diverse group and I don’t think there is a common voice. I am a physician and would be thrilled to have a universal payer system. Currently there is way too much overhead in dealing with so many insurance companies. We’re already paying for the healthcare of the uninsured (through emergency care, disability checks to those whose disability could have been prevented, and community clinic subsidized by state/federal programs)so I don’t see why we don’t do it in a way that makes sense and would be cheaper (ie preventative care).

just my two cents….

[Nicole]

Doctors are a diverse group and I don’t think there is a common voice. I am a physician and would be thrilled to have a universal payer system. Currently there is way too much overhead in dealing with so many insurance companies. We’re already paying for the healthcare of the uninsured (through emergency care, disability checks to those whose disability could have been prevented, and community clinic subsidized by state/federal programs)so I don’t see why we don’t do it in a way that makes sense and would be cheaper (ie preventative care).

just my two cents….

[equalizer]

[quote=jpinpb]I agree it is an issue of INSURANCE and not healthcare. I remember listening to some argument, I think on KPBS, about whether illegal aliens should have access to this insurance. One side was saying no. The other side was saying yes, b/c more people will lower the insurance and actually cost taxpayers less b/c otherwise the illegal aliens will go to the emergency room and taxpayers will pay for it anyway, only more.

Exactly as ucodegen mentioned about the 30% off on the MRI. Have any of you gone to a doctor w/out insurance and they cut you a break on the price? I say insurance IS the reason healthcare is so expensive.

With regard to bipartisan support, I had posted this on a thread, Nixon’s plan for healthcare reform. I guess Democratic congress was against it. Here we are 35 years later still dealing w/it, only roles reversed.[/quote]

Insurance is the reason that health care costs are so high and quality is subpar (at least 100K deaths from hospital infections/mistakes)
It is well laid out in this long article below which is titled
“How American Health Care Killed My Father”. Highly recommended for anyone who cares to understand the issues.

Simple solution: Require catastrophic insurance for everyone (subsidy for poor) and have users pay (edit-) cash for everything else. This will increase competition, increase quality of care, and reduce costs.

If you don’t believe this, come to dark side and I will show the best (simple, low-to-medim risk) investment over last 25 years. Yep, Vanguard Healthcare Fund, nearly 17% annualized return over last 25 years by my friend Edward P. Owens. There has been a lot of profit made in that sector that came from the insured.

A solution that even sduude can support!

http://www.theatlantic.com/doc/200909/health-care/2

[equalizer]

[quote=jpinpb]I agree it is an issue of INSURANCE and not healthcare. I remember listening to some argument, I think on KPBS, about whether illegal aliens should have access to this insurance. One side was saying no. The other side was saying yes, b/c more people will lower the insurance and actually cost taxpayers less b/c otherwise the illegal aliens will go to the emergency room and taxpayers will pay for it anyway, only more.

Exactly as ucodegen mentioned about the 30% off on the MRI. Have any of you gone to a doctor w/out insurance and they cut you a break on the price? I say insurance IS the reason healthcare is so expensive.

With regard to bipartisan support, I had posted this on a thread, Nixon’s plan for healthcare reform. I guess Democratic congress was against it. Here we are 35 years later still dealing w/it, only roles reversed.[/quote]

Insurance is the reason that health care costs are so high and quality is subpar (at least 100K deaths from hospital infections/mistakes)
It is well laid out in this long article below which is titled
“How American Health Care Killed My Father”. Highly recommended for anyone who cares to understand the issues.

Simple solution: Require catastrophic insurance for everyone (subsidy for poor) and have users pay (edit-) cash for everything else. This will increase competition, increase quality of care, and reduce costs.

If you don’t believe this, come to dark side and I will show the best (simple, low-to-medim risk) investment over last 25 years. Yep, Vanguard Healthcare Fund, nearly 17% annualized return over last 25 years by my friend Edward P. Owens. There has been a lot of profit made in that sector that came from the insured.

A solution that even sduude can support!

http://www.theatlantic.com/doc/200909/health-care/2

[equalizer]

[quote=jpinpb]I agree it is an issue of INSURANCE and not healthcare. I remember listening to some argument, I think on KPBS, about whether illegal aliens should have access to this insurance. One side was saying no. The other side was saying yes, b/c more people will lower the insurance and actually cost taxpayers less b/c otherwise the illegal aliens will go to the emergency room and taxpayers will pay for it anyway, only more.

Exactly as ucodegen mentioned about the 30% off on the MRI. Have any of you gone to a doctor w/out insurance and they cut you a break on the price? I say insurance IS the reason healthcare is so expensive.

With regard to bipartisan support, I had posted this on a thread, Nixon’s plan for healthcare reform. I guess Democratic congress was against it. Here we are 35 years later still dealing w/it, only roles reversed.[/quote]

Insurance is the reason that health care costs are so high and quality is subpar (at least 100K deaths from hospital infections/mistakes)
It is well laid out in this long article below which is titled
“How American Health Care Killed My Father”. Highly recommended for anyone who cares to understand the issues.

Simple solution: Require catastrophic insurance for everyone (subsidy for poor) and have users pay (edit-) cash for everything else. This will increase competition, increase quality of care, and reduce costs.

If you don’t believe this, come to dark side and I will show the best (simple, low-to-medim risk) investment over last 25 years. Yep, Vanguard Healthcare Fund, nearly 17% annualized return over last 25 years by my friend Edward P. Owens. There has been a lot of profit made in that sector that came from the insured.

A solution that even sduude can support!

http://www.theatlantic.com/doc/200909/health-care/2

[equalizer]

[quote=jpinpb]I agree it is an issue of INSURANCE and not healthcare. I remember listening to some argument, I think on KPBS, about whether illegal aliens should have access to this insurance. One side was saying no. The other side was saying yes, b/c more people will lower the insurance and actually cost taxpayers less b/c otherwise the illegal aliens will go to the emergency room and taxpayers will pay for it anyway, only more.

Exactly as ucodegen mentioned about the 30% off on the MRI. Have any of you gone to a doctor w/out insurance and they cut you a break on the price? I say insurance IS the reason healthcare is so expensive.

With regard to bipartisan support, I had posted this on a thread, Nixon’s plan for healthcare reform. I guess Democratic congress was against it. Here we are 35 years later still dealing w/it, only roles reversed.[/quote]

Insurance is the reason that health care costs are so high and quality is subpar (at least 100K deaths from hospital infections/mistakes)
It is well laid out in this long article below which is titled
“How American Health Care Killed My Father”. Highly recommended for anyone who cares to understand the issues.

Simple solution: Require catastrophic insurance for everyone (subsidy for poor) and have users pay (edit-) cash for everything else. This will increase competition, increase quality of care, and reduce costs.

If you don’t believe this, come to dark side and I will show the best (simple, low-to-medim risk) investment over last 25 years. Yep, Vanguard Healthcare Fund, nearly 17% annualized return over last 25 years by my friend Edward P. Owens. There has been a lot of profit made in that sector that came from the insured.

A solution that even sduude can support!

http://www.theatlantic.com/doc/200909/health-care/2

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