Beware of Reference Pricing

[somarco]

The Obama administration has given the go-ahead for a new cost-control strategy called "reference pricing." It lets insurers and employers put a dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements.

Some experts worry that patients could be surprised with big medical bills they must pay themselves, undercutting financial protections in the new health care law. That would happen if patients picked a more expensive hospital — even if it's part of the insurer's network.

Cost-control plan for health care could cost you

 

[AllenChicago]

Rationing by any other name... Hate to see this. Hip and Knee replacements are common and becoming more so as America ages. It's more important now than ever for patients to call their insurer, obtain advance authorizations, and write down the confirmation number in case the authorization system crashes, or suffers amnesia when the bills are due.
ac

 

[VolAgent]

In what world is a $5,000 deductible the devil incarnate, but a cap on what an insurer will pay on a procedure that leaves the insured exposed a good thing?

Is a hospital more likely to chase you down for your deductible afterwards, or insist you show the ability to pay after the insurer's cap before performing a non-emergency procedure?

 

[unic.consulting]

In what world is a $5,000 deductible the devil incarnate, but a cap on what an insurer will pay on a procedure that leaves the insured exposed a good thing?

Is a hospital more likely to chase you down for your deductible afterwards, or insist you show the ability to pay after the insurer's cap before performing a non-emergency procedure?

One of the biggest problems with this is that often patients and doctors won't know about this until AFTER the procedure.

 

[VolAgent]

One of the biggest problems with this is that often patients and doctors won't know about this until AFTER the procedure.

Good chance. But I'm pretty sure the doctor and hospital are going to put a lot more effort into getting 30,000 or more from you versus 5,000.

 

[unic.consulting]

Good chance. But I'm pretty sure the doctor and hospital are going to put a lot more effort into getting 30,000 or more from you versus 5,000.

Nah...they're going after you either way...that's what collection agencies are for. I do agree that the reference pricing is worse than a high deductible. At least then, most people have half a clue about what's going on.

 

[Yagents]

Weren't republicans vilified for recommending a fixed "stipend" for medicare, putting the senior at risk for costs above that amount? It's no longer just grandma being pushed off the cliff, we're all going with her now.

 

[unic.consulting]

Weren't republicans vilified for recommending a fixed "stipend" for medicare, putting the senior at risk for costs above that amount? It's no longer just grandma being pushed off the cliff, we're all going with her now.

And it's not better just because someone else is doing it. There are better ways to control costs.

 

[stuy119]

It's no wonder the insurance companies haven't really pushed back on the ACA. And it's a good thing that Obama promised people better coverage at better rates.

Everyone gets what they deserved for falling for that bullsparkle.

 

[somarco]

Weren't republicans vilified for recommending a fixed "stipend" for medicare, putting the senior at risk for costs above that amount?

That wasn't the way it worked, at least not the Ryan plan. He proposed a voucher system. You had $X to spend on your policy and you could go wherever you wanted, or buy nothing at all. It's really no different than now with the MA options but people made it into something horrible.