September 6th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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I have described how the healthcare insurance industry loads its expenses into direct patient care expenses to increase their profits.
The Medical-Loss Ratio calculation is not reported by the traditional media. The healthcare insurance industry spends less healthcare dollars on direct patient care after it is permitted by federal and local agencies to load its expenses into the direct patient care column.
Simply put, the healthcare insurance industry cooks the books to increase its net profit.
Another way to increase profits is to shortchange physicians on medical claims. In fact, 20% of medical claims payments are inaccurate according to the American Medical Association’s (AMA) fourth annual National Health Insurer Report Card. Claims-processing errors by health insurance companies waste billions of dollars and frustrate patients and physicians.
This is one of the reasons the RAND report about physicians controlling waste is so absurd to me. The healthcare insurance industry creates waste in order to increase net profit. Read more »
*This blog post was originally published at Repairing the Healthcare System*
August 3rd, 2011 by Happy Hospitalist in Opinion, True Stories
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Childbirth hospital costs these days aren’t cheap. Some studies suggest the cost of raising a child exceeds $200,000, not including education expenses. Most insurance companies charge women of childbearing age more for their insurance because the actuarial tables say so. Mrs Happy and I now have a 3 month old Zachary in our wings. He is a cute little peanut. His two brothers, Marty and Cooper adore him.
Forty-two days after his April 21st, 2011 delivery, we still had not received our explanation of benefits from Blue Cross Blue Shield for the midwife charge. I had previously received a statement from them saying the charge was under review. Perhaps they believed that delivering Zachary was not medically necessary. I can’t explain it.
When I called to ask them why this charge had not been approved, they said they could not give me a reason why my explanation of benefits statement had not been finalized after 42 days. I pressed for more information, but to no avail. I was given no reason other than to say that they had a lot of claims to review. That’s not an acceptable reason to delay a payment of a claim. Read more »
*This blog post was originally published at The Happy Hospitalist*
December 8th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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Blue Cross Blue Shield of Massachusetts and Caritas Christi Health System are announcing a new agreement that some suggest may be a model for the rest of the country.
Under it, the non-profit insurer will stop paying the non-profit hospital on a fee-for-service basis for certain insureds:
Under the deal expected to be announced Friday, Caritas . . . will be paid to take care of about 60,000 Blue Cross members in its new program — whether or not they get sick. Caritas will use some of the payments for preventive services to help keep patients healthy. If Caritas can keep health-care costs under a certain budget, it can make a profit. But if health-care costs go over the agreed-on amount, Caritas is on the hook. . . . . Blue Cross is adding a carrot: If doctors and hospitals can meet certain quality targets, they can earn a bonus of as much as 10% on the value of the deal. Read more »
*This blog post was originally published at See First Blog*
