[…] David also points out that the amounts allowed by his Blue Cross Blue Shield carrier don’t seem to have anything to do with the amounts billed by his physical therapies – the lowest allowed amount on his EOB was for the service that was billed with the highest price tag. We’ve also seen little rhyme or reason (that we can detect, anyway) in terms of how billed amounts and allowed amount correlate. […]
[…] Although I’m a bit perplexed by the $99,000 median household income figure cited in the Rand study, I think that the gist of the study – basically the fact that health care is eating up a huge portion of family and government income in America – is important for people to understand. We can’t tackle a problem without first knowing what the problem is. And one of the obstacles in the way of curtailing health care costs in the US is that our current system is so convoluted and complex that it’s nearly impossible to see all the areas where health care spending is impacting us – at the federal, state, and household levels.
[…] This should help boost public participation in the rate review discussion, and add to the general understanding of how the rate review process works. The DOI is obviously working hard to create as much transparency as possible with regards to rate increases. Rates will continue to increase as long as the cost of health care continues to climb (and as long as we continue to increase our utilization of health care) but at least the logic behind the rate increases will be more clear.
The Colorado Health Plan Description Form isn’t exactly the same as the forms that HHS will require carriers to make available next year, but it’s similar in many ways, and carriers in Colorado have been issuing these standardized plan summaries for nearly 14 years. As well as outlining the coverage provided, the new forms will include “coverage examples” that will show potential customers how the plan would cover three common medical scenarios: breast cancer, maternity care, and diabetes. […]
[…] Colorado will get $1 million to use for more extensive review of future rate increases, and the Division of Insurance has proposed hiring more analysts and actuaries to examine the data that is filed each year by the insurance carriers. The rate proposals will get more scrutiny, which is a good protective measure for consumers. But insureds could still see hefty rate increases thanks to the ever-increasing cost of health care. […]
David Williams has written an excellent article about the overuse of mammography screening in older women with cognitive impairment. When you read his article, especially the part about how women with a higher net worth are more likely to be screened, it’s obvious that money is playing a large role when it comes to determining who should get mammograms. […]
[…] One of the problems facing our health care system is that there are so many people involved who are looking out for their own best interests, rather than what is best for the system as a whole and patients as individuals. The sheer force of the lobbying power that has descended on Washington this summer is evidence of that. […]
[…] I believe that most people who become medical providers do so out of a genuine desire to help people. But then they get caught up in paperwork, health insurance regulations, overcrowding and under-staffing, malpractice litigation fears, and a whole range of other things that don’t really have anything to do with providing care. I was struck by how many articles mentioned sincerely listening to patients as advice for providers.
[…] Pricing varies from one provider to the next; negotiated reimbursement rates vary within a single health insurance network; patients often don’t know what the price will be until after the fact. And as David Williams pointed out, the prices are often far from reasonable. We can’t do without healthcare, and that’s why unreasonable “reasonable and customary” charges exist.
[…] Provider quality rankings are a piece of the puzzle for sure, but they’re not the only piece. I do think they will get more popular if health insurance carriers start actively encouraging patients to select from among the highest ranking providers. But there are other factors that go into choosing a provider that can’t be quantified on a spreadsheet or a graph.
If you’re wondering what to do with yourself now that the election is over and you can’t listen to pundits debate the finer points of political campaigning, the Health Wonk Review is here to entertain and educate. So how exactly will health care reform fare under our new […]
Anthem Blue Cross Blue Shield has introduced a useful tool for their Colorado health insurance members. It’s time to lift the veil of secrecy that surrounds network negotiated pricing. Health care is too important – and way too expensive – for consumers to have to guess when it comes to pricing and picking a provider […]
Included in the ratings are Aetna, Anthem BCBS, Cigna, Coventry, Health Net, Humana, United Healthcare, and Medicare. In the individual health insurance market in Colorado, we deal extensively with Aetna, Anthem, Humana, and United Healthcare, so I was especially curious […]
We got a bill last week for $397 from the company that provided Jay’s crutches, knee brace, and ice machine when he had knee surgery in January. The surgery was done at the Vail Valley Medical Center in Vail, Colorado, by Dr. Steadman; both the hospital and the doctor are on our Humana PPO network…. Read more about Surprise Medical Bill from Out-of-Network DME Provider
In CA, regulators are working to impose a ban on “balance billing” – the practice of billing patients for amounts over what their health insurance companies will pay for a given procedure. While most health insurance networks prohibit balance billing, there are only eight states that regulate the practice, and a good number of patients… Read more about Why Is There A Balance To Bill In The First Place?
When Jay had an MRI on his knee last month, we were charged $1200. The EOB tells us that the Vail Valley Medical Center in Vail, Colorado, charges $1600 for the procedure. Our Humana health insurance has a negotiated rate of $1200, which is what we paid (we hadn’t met the deductible yet, so we… Read more about More Transparency For Network Negotiated Prices
The Colorado Blue Ribbon Commission for Health Care Reform made its final report to the Colorado General Assembly last week. The 176 page document was endorsed by 24 of the 27 diverse commissioners, and includes provisions that the Commission says will reduce the number of Coloradans without health insurance (currently 792,000 people) by 88%. The… Read more about Colorado Blue Ribbon Commission Report Finalized
With health insurance premiums on an every-increasing trend, employers and individuals have been looking for ways to cut costs. High deductible health insurance plans in combination with health savings accounts have been widely touted by government officials as a way to lower costs. Indeed, the premiums for an HDHP are generally lower than premiums for… Read more about Not A Lot Of Comparison Shopping with HSAs Yet
Note: This is the fourth entry in my price transparency experiment. See the first entry here, the second entry here, the third entry here, and the fifth entry here. Jay has written several times over the last month about his lipoma surgery and the billing headache that it has become. When we got the bill… Read more about Humana Says the Price is a Secret
Note: This is the third entry in my experiment with price transparency in the US health care system. See the first entry here, the second entry here, the fourth entry here, and the fifth entry here. I finally got the bill for the surgery (pdf). It was quite high compared to the estimate I received…. Read more about I Got the Bill