Time to End This Ridiculous Practice

#1

Now some of us, if we knew such an arrangement was in place to pay out of network providers, would use the checks to, :thinking:, pay those providers for services rendered.

But do insurers seriously think all patients can be trusted on a sort of honor system like this? Particularly one who has just left rehab?

Perhaps it’s time to end this practice and either go on an HMO like system—where out of network care isn’t covered at all—or directly pay out of network providers, even at a reduced rate.

#2

The issue is that a lot of out of network providers will not accept payment from the insurance companies. Depending on the claim amount there is a negotiation process that insurance companies can enter into with the OON provider and if it is successful it results in the provider accepting the insurance companies allowed amount and reimbursement direct to them.

As for excluding OON benefits a significant number of employer sponsored plans are self funded where the employer decides on the benefits. All the insurance company provides is administration services.

But how can the insurance company be expected to know who can be trusted and not trusted with an out of network payment?

#3

Why are hard cases and exceptional idiots used this way?

The guy made his choice and he’s dead. Too bad for him. Let him go to stand before his maker and leave the rest of us unmolested by yet more solutions to protect people like him from themselves.

#4

Obama care…

1 Like
#5

What about it?

#6

It’s our current medical system…Right?

#7

Nope.

#8

Yes, it is…Obama and the dems passed it. Now they seem to hate it…

#9

Nope its a method to get insurance.

#10

If I’d been in charge of the Republicans in Congress when at the first opportunity a full repeal came down the pike I’d tell the Democrats they wouldn’t be able to know what was in it till they voted for it.

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#11

:face_with_hand_over_mouth::flushed:

#12

The problem with everyone quoting that statement from Pelosi is that it is ALWAYS taken out of context.

It’s easy to cherry-pick people’s words - it happens on both sides of the aisle in politics and in all walks of like unforunately…no one ever seems to learn their lesson that cherry picking is just a cute way of lying.

The full context in which Pelosi stated those words makes it clear that she was not saying that people shouldn’t know what’s in the bill til they vote for it.

Here’s the proof:

#13

That was a sad attempt to call it out of context…lol!

#14

The issue highlighted by the OP has nothing to do with Obamacare. ACA did not impact payments for OON providers going directly to customers. It was done before the ACA and continues today and will continue to do so.

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#15

So, What good was Obama care? Even the dems, want it replaced now…

#16

I have never been a huge supporter of the ACA. It had a few useful planks but overall it was health insurance reform and not health care reform.

However if both sides had been willing to have an open and honest debate aBout healthcare then ACA would never have happened.

The issue will never be resolved as long as dems talk incessantly about free at point of service healthcare for all and when republicans just stick to the mantra that the US healthcare system is the best in the world and just let the free market prevail.

The problem is that the electorate have allowed themselves to be polarized and therefore no one is keeping their elected representatives accountable.

#17

I wish the reps would let the free market prevail. But many don’t seem to trust it anymore than the dems. Even though the free market provides us with that vast majority of goods and services we want at affordable prices.

And if dems want to form co-ops to pay for each other as some Christian groups are doing that would be fine and should be encouraged by law.

I would really like to see legislation to stop employers from picking people’s health insurance for them, and allow vouchers to let employees pick their own. That may sound different but a single payer system would have to outlaw private insurance anyway…

It would also be nice, that since the left is always touting Norway, that they were informed on what Norway does,and who’s taxed to pay for it. Norway has a about 5 million people so individual states could follow their model, and there is little need for a national system.

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#18

The UK has a National Health System and a thriving Private Health Insurance sector. It is completely wrong to blanketly state that a socialized form of health care provision cannot co-exist with the private sector.

The problem is that the co-pay model of health insurance did not force providers to compete. The end user did not care what the underlying cost was and therefore had no incentive to be a consumer. With Health Spending Accounts that is changing and providers are reacting to that change. In addition cost transparency tools for the first time allows customers to see the true cost of a service. Would you buy a car or purchase a television without knowing the cost until after you have purchased it? Of course not so why should health care be different.

Other innovations are the way providers are reimbursed. Traditional they have been paid fee for service which encouraged a factory line mentality with little focus on continuing or preventative care. Now we are seeing payment models that are valued based on clinical and healthcare outcomes. For example a doctor who reduces the number of ER visits for an asthma patient is financially rewarded. At first providers were suspicious of this but as these pilots expand the feedback is favorable for both patients and providers.

BTW it was the ACA which has kickstarted health insurance companies and providers to become innovative so even though that was not the intent of the ACA it is definitely a beneficial byproduct.

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