Open thread Dec.13, 2013 Dan Crawford | December 13, 2013 8:04 am Tags: open thread Comments (11) | Digg Facebook Twitter |
The Obama administration is facing a huge hurdle, as many exchange policies and some of the infamous individual market policies will not be in effect by January 1, may not be billed until sometime in January, and so really will not be in force until who knows when.
The feds are “encouraging” insurers to pay claims beginning on January 1 anyway. Hmmmm.
Also, not only are insurers putting together “narrow networks” but may not even know which providers are in the network until some unknown time in the future. Many patients will eventually get a rude shock, and also may find themselves “out-of-network” (OON) for claims retroactively.
The feds are encouraging insurers to treat many of these claims as “in network” even when the claims are OON. Providers who have time to think ahead are expecting chaos at the front desk and worse chaos in the billing department.
Some of us are notifying providers to expect a great deal of slow pay or no pay for first quarter claims, at the very best.
This is going to be a circus – a really dysfunctional circus.
“not only are insurers putting together “narrow networks” but may not even know which providers are in the network until some unknown time in the future””
I would need to see something that shows this is true.
How can insurers both create narrow networks and not know who is in the network?
According to minimum wage critic David Neumark, $55 billion is transferred yearly to poor families by the E.I.T.C. * — and that says it all. That represents about a third of one-percent of our $16 trillion economy.
That closely equates a minimum wage raise of $1 an hour — which would shift about $40 billion out of our $16 trillion — or about a quarter of one percent of overall income — from the 85-90% who earn more than $8.25 an hour to the 10-15% below (I don’t have exact figures here).
The bottom 20% of earners now take 2% of overall income — big help. Neither path offers much hope of lifting working families out of poverty. The E.I.T.C. does not even pretend to help the single worker.
A $15 an hour minimum wage OTH would shift about $560 billion from the 55% who now take 90% of overall income to the 45% of Americans who take only 10% — or about 4%. I don’t foresee the 55% tellling the 45%: Stay home; we don’t need your output anymore, over a 4% overall price increase.
* * * * * *
It occurred to me recently — after reading a very pro-minimum wage raise piece in the NYT — that most of of today’s pro-raise pieces could have been written in January 1967, when the potential minimum was near $11 an hour (as we know from history) — but when PER-CAPITA OUTPUT WAS ABOUT H-A-L-F TODAY’S (to be precise, that would be if the minimum were $7.25 in 1967 January rather than $8.75).
The Lucas County (Toledo) Ohio commissioners are dumping spouses off county health plans effective March 1st.
Lucas County is a bastion of liberal, very pro-union, near total Democratic politics, so it is not like to GOP is doing this to workers.
One of the commissioners, who I believe is a former union business agent, said this is why we have the ACA so we are going to use it.
Dependents will still be covered.
Absolutely. One that has been going on for years and years as from 2000-2010 17% of the people who had health insurance through their employers lost their coverage.
Course, before the ACA those people did not have many places to go……….
“Putting together” implies they are still working on the process, right? Late start, poor communications with providers, the usual complexities of contracting, cloudy information on reimbursement rates, etc.
Apparently you miss the irony of liberal pro-union Democrats cutting compensation by dumping spousal coverage.
This thread is an example of some of the problems involved in evaluating what are broad changes in insurance policy and their connection to the ACA.
Using MA as an example, there have been major snafus ‘unrelated’ to the ACA mandates, but are related to big changes occurring within the industry. MA might serve as an example of the problems insurance companies have run into before ACA. To be upfront, I find it hard to separate out what are the confusions of specific current implementations and snafus that occur as the industry changes overall practice to obtain ‘efficiencies’
1. Electronic records
1. Electonic records were mandated by the Big Five hospitals who had enough clout in state to make it happen. It has taken several years to make it happen (since 2007). Adjustments to how one entered notes in the laptop simultaneous with the patient interview is still a problem (at least for me) since I tend to observe body language and such as part of the interview, and not simply verbal responses. I can’t type using touch mostly and maintain eye contact with the patient. Short cuts to entering information are not as thoughtful.
Even to this day software systems remain full of glitches and are not compatible with other systems. I do not know of any that have emerged as superior.
2. Electronic billing and payment (no Checks) went into effect this November. However, last year a new coding system by Blue Cross was put into place, which meant many providers did not receive checks for up to FOUR months during the changeover. This was a private enterprise mandate to providers. Small marginal providers did not survive (I have no numbers)…four months pay while expenses remained the same was hard to bear.
The new software spit out wierd stuff…with a letter saying the client would receive the check for service to give to the provider would come the check also…or the check would go to the client but the provider would be notified a check would be direct (now a electronic deposit).
Mispayment is common enough to create confusion as new rates have been determined per contract…even to having the provider actually return money because they were ‘overpayed’ but had not received notice of the new rates. Rates are continually being reduced to providers at least in mental health.
3. Networks have been narrowing by region in the state, with most choices being centered in higher density areas (city and suburb) than in more rural areas (which have been way underserved for years). Some providers received notice they were no longer in network with some clients, but continued to be in network with other clients. These things were over time straightened out mostly with a lot of phone time.
4. Pricing is also considered proprietary between hospitals and insurance, but we do know regular and routine care is priced considerably lower for many procedures in the suburbs compared to Boston Five.
I think the transitions are hard. This is not to say what Rusty is observes is not accurate. I do know it would be tempting for CEOs to blame troubles with ‘everything’ on Obamacare, whether ot not it is.
Yep, medical billing has been a nightmare for decades. Blaming it on the ACA is silly.
My back surgeon does his notes with voice recognition.
“Apparently you miss the irony of liberal pro-union Democrats cutting compensation by dumping spousal coverage” Rusty
No I don’t. These kind of things have been happening to Dems and Reps for a long time before we even heard the name Obama.
Apparently you missed the last couple of decades in healthcare problems in the US(strange since it seems to be your job) as you consider all of them to be caused by the ACA.
By Sam Baker
December 12, 2013
Welcome to the Obamacare era.
The healthy are subsidizing the sick. Insurance companies are tightening access to doctors. Plans with low premiums have high deductibles. Sometimes it rains, Nickelback is still a band, and people continue to die literally every day.
But just because something is happening and Obamacare exists doesn’t mean it’s happening because Obamacare exists—even in health care.
Don’t tell that to the law’s critics: The Affordable Care Act has become the go-to scapegoat for just about everything people don’t like about health care, if not in the economy overall. The law is being blamed for trends, economic incentives, and basic realities that it did not create and that were part of the health care system long before President Obama was even elected.
Probably the best question to ask the naysayers and the “what about this” crowd (STR) is “why are we here today implementing a federal insurance program?” It certainly is not being done because commercial healthcare insurance was making efforts to help provide affordable healthcare for individuals. Clearly healthcare insurance providers do not care about the uninsured unless they can ante up. Healthcare Insurance was not the bulwark preventing or slowing the rising cost of healthcare or negotiating with much strength with the healthcare industry slowing its costs. There promise was more of the same with the Public (even the insured) being forced into picking up the cost of the uninsured through the back doors and at a much higher cost.
Could it be better than the PPACA, yep it could; however, the Senator from Aetna Liberman killed some options and much of Congress was not interested in changing the status quo. The PPACA will morph into something better, insurance companies will morph into providing supplementary insurance perhaps, and consultants such as STR will find another job.